medicare plans

Medicare Advantage Enrollment

Are you ready for Medicare open enrollment in 2019? When Medicare open enrollment starts, it’s time to consider your health plans and the prescription for next year. The 2019 Medicare open enrollment period is from October 15th, 2018 to December 15th, 2018 for a January 1st, 2019 effective date.

Even if you are with your prescription benefits and current Medicare health, you need to ensure that the plan will be similar next year. Because plans do change, and the period after Medicare open enrollment is when those changes will show up.

What is Medicare Advantage?

A. Medicare Advantage plans are a hybrid of coverage offered by an insurance company. When you are eligible for Medicare at age 65, you select Part C–Medical Insurance offered by a company. You still pay your premiums out of your social security check for Part B but the government pays the insurance company to administrate the benefits. These Medicare Advantage Plans appear to have many benefits and include Drug coverage (Part D). Medicare Advantage plans are the best of both worlds but they have some drawbacks. If your doctor is not a Medicare Advantage plan doctor, you will pay additional costs to see him/her but with most plans, you can see another doctor (usually not available with HMO plan). You will be subject to separate deductibles and separate co-payments and often need a referral for approval before you can get care from the specialist. If you do not get a referral, the plan may not pay for your care.

Q. Medicare Advantage provides all Medicare health care through that plan, what if I don’t like it? I have heard Doctors payments will be cut and the company I sign up with may stop insuring them. What protection do I have?

A. Medicare is a government-provided plan for those 65 and older, you have many options for coverage. Every November 15 through December 31 you can switch from one Medicare Option to another–you can enroll in any Medicare Advantage or Part D at this time. This is called the Annual Enrollment Period. (AEP) Your new coverage would begin on January 1. From January 1 to March 31 Medicare members can make ONE plan change to a like kind. For example, you can change to another MA plan. The member CANNOT change Part D coverage during this time unless they have it with the plan they are leaving. This is called the Open Enrollment Period (OEP). During the Special Enrollment Period (SEP), members must enroll within 63 days of a special event. This is if you move outside the service area, move into or out of a long-term care facility, loose credible prescription drug coverage, return to the US from another country or get assistance from the state in which you live, loose coverage under an employer or union either voluntarily or involuntarily.

Q. What other benefits do I get with a Medicare Advantage Plan?

A. You may get extra benefits by selecting a Medicare Advantage Plan. These may include vision, hearing, dental and/or health and wellness program including membership to a specific gym. Because you do not need to buy a Medigap or Medicare Supplement policy, the premium is supplemented by the government and are less expensive than a traditional supplemental plan.

Q. I hear there is many gaps in the Part D (Drug) coverage and I take 5 prescriptions a day. How do I get most of my drugs covered?

A. Every insurance company that offers Part D coverage has a written list of drugs. These include generic and brand name drugs. (Check the websites or ask your agent for a printed formulary drug book.) Your plan may have several tiers and your co-payment amount depends on which “TIER” your drug is listed. Not all brand names will be covered and these can be very expensive if you have a high copayment or it is not listed. Always ask your doctor whether the drugs prescribed are available as generic. Be sure to ask your doctor whether you can split a high-dose version of the prescribed drugs as


Part C premium: The Part C monthly premium varies by plan


What you pay in a Medicare Advantage Plan

Your out-of-pocket costs in a Medicare Advantage Plan (Part C) depend on:

*Whether the plan charges a monthly premium.

*Whether the plan pays any of your monthly Medicare Part B (Medical Insurance) premium.

*Whether the plan has a yearly deductible or any additional deductibles.

*How much you pay for each visit or service (copayment or coinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.

*The type of health care services you need and how often you get them.

*Whether you go to a doctor or supplier who accepts an assignment if:

: You’re in a PPO, PFFS, or MSA plan.

: You go out-of-network.

*Whether you follow the plan’s rules, like using network providers.

*Whether you need extra benefits and if the plan charges for it.

*The plan’s yearly limit on your out-of-pocket costs for all medical services.

*Whether you have Medicaid or get help from your state