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Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of the new book, “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil.
Medicare annual enrollment, which begins Oct. 15 and runs through Dec. 7, promises to be unusually important this year and, I say with regret, even more complicated than usual. To help you make the right Medicare choices, I will be providing step-by-step guidance in a half dozen or so installments in the coming weeks.
My main message today is that you should carefully look at your current Medicare coverage and think seriously about changing plans in 2019. Studies regularly find that people can save money and improve coverage by switching plans. Also, you need not be in a rush! You have more than two months to act. Even decisions made on Dec. 7 still will take effect next Jan. 1.
In addition, and this is part of this year’s possible confusion, if you have a Medicare Advantage plan, you also will have the entire first quarter of next year to change your plan. That includes the option to drop Medicare Advantage entirely and use original Medicare plus getting a Part D drug plan and perhaps a Medigap supplement plan as well. Changes made during this period will take effect on the first of the following month.
The Centers for Medicare & Medicaid Services (CMS) has overseen a substantial expansion in Medicare Advantage plans, implementing new laws and using its regulatory authority to give these private insurance plans expanded flexibility to cover non-medical supplemental benefits and package them in new kinds of plans.
These benefits may include coverage of things like bathroom grab bars to make homes safer for seniors, transportation to medical appointments and even healthy meals delivered to seniors’ homes.
The CMS rule changes came too recently for insurers to make widespread use of them in 2019 plans. CMS reports that nearly 270 Medicare Advantage plans with about 1.5 million enrollees – fewer than 7 percent of total Medicare Advantage users — will be providing such supplemental benefits next year. Larger-scale changes to plans are expected in 2020.
Medicare Advantage plans have become increasingly popular, with more than a third of beneficiaries having these private plans and just under two-thirds still having original Medicare. The government’s decided tilt toward Medicare Advantage plans is expected to further encourage their growth. And while Medicare advocacy groups generally support expanded benefits, they are concerned that people who rely on original Medicare are not being given comparable new tools.
If you have a private Medicare plan – a Medicare Advantage plan or a Part D drug plan – your insurer should have provided you a comprehensive look at 2019 plan costs and major plan changes, as well as a complete look at what your plan covers.
The 2019 update is contained in a document called an Annual Notice of Change. The plan’s comprehensive rules are provided in an Evidence of Coverage (EOC) document, and if you have a Part D drug plan, your EOC should also include or refer you to the plan’s complete list of the drugs it covers (called a formulary) as well as details on how it charges for covered drugs. Medicare rules require insurers to have distributed ANOCs and EOCs by the end of September.
As of Oct. 1, Medicare says, its online Plan Finder has been updated with complete 2019 plan details. Making informed use of Plan Finder is so important that I will devote an entire piece to it later this month. For now, I’d urge you to at least look up your existing plans in Plan Finder and compare them with other plans available where you live.
If you have questions, you will have plenty of time to get them answered. My recommended source for free help with 2019 Medicare decisions is the State Health Insurance Assistance Program (SHIP). It has offices in every state and people who can help you navigate Medicare annual enrollment decisions.
Here are the highlights for key changes from 2018 to 2019:
CMS says the average Part D premium in a basic drug plan will be reduced by $1.09, or 3.2 percent, to $32.50 a month.
The Part D coverage gap, also known as the donut hole, will end in 2019 — a year earlier than planned, thanks to a law passed by Congress. This means that consumers will pay 25 percent of the cost of their brand drugs, and 37 percent of the cost of generic drugs, once they reach the coverage gap. This gap was triggered this year once insurer and beneficiary costs had reached $3,750. Once consumer out-of-pocket spending reached $5,000 this year, people entered the catastrophic phase of Part D plans, at which time their maximum payment fell to 5 percent of a drug’s price. CMS has yet to announce 2019 trigger amounts.
There are 3,700 different Medicare Advantage plans for 2019 – an average of nearly 35 per county – up from 3,100 last year.
The Medicare Advantage average premium will decrease $1.81 to $28 a month, according to CMS. Roughly a quarter of existing Medicare Advantage users will have lower premiums if they stay with their current plans, and nearly 60 percent more will have the same premium. Nearly half of enrollees would pay zero premiums if they stayed with their current plans.
CMS says that Medicare Advantage enrollments are projected to grow by 2.4 million to 22.6 million, or 36.7 percent of expected total Medicare enrollees.
And now, here are few reader questions.
Elizabeth – Alaska: I recently became disabled and got my first check from Social Security this summer. My husband left me when I got sick, but I still have a house in Michigan and am responsible for the mortgage. I am currently on my husband’s health insurance, but I believe I will have to make Medicare decisions soon and need your advice.
I have been staying in Alaska as a dear friend has helped me out financially. Although I am sick, they are worse off than me. God works in mysterious ways; we are blessed to have each other, as my feet still work and his do not.
The question is, what kind of Medicare should I pick that works in both Alaska and Michigan? Is there a supplemental policy also that works in both places? I have one medicine I take currently that cost $1,200 a week that is covered under my husband’s insurance, but I fear it will not be covered under Medicare.
I make only $1,700 a month on disability. I had to sign over my work pension to my husband so he would agree to keep me on his health insurance. I am very confused about what to do.
Phil Moeller: Well, Beth, if Hollywood ever decides to remake the Story of Job, you have my vote for the starring role! I think the first thing you need is an aggressive attorney to get some money from your husband and perhaps a big piece of his hide as well.
As for Medicare, original Medicare (Parts A and B) and a Medigap supplemental plan will work anywhere in the U.S. This is comprehensive coverage but can also be expensive.
Part D drug plans will only cover you in your home market, but you should be able to get 90-day prescriptions that will permit you to travel without worrying about running out of your medications. Despite your worries, Medicare drug coverage is comprehensive. You can use Medicare’s online Plan Finder to see which Part D plan covers your prescribed drugs for the least cost.
Medicare Advantage plans cover everything that the above package covers, and usually cost much less. The trade-off is that these plans may not cover you in both places, and they also may limit care to only those doctors and hospitals in a plan’s coverage area.
The State Health Insurance Assistance Program (SHIP) provides free Medicare counseling and should be a good first step to help you begin comparing Medicare coverage plans. However, SHIP counselors often are not equipped with details about specific Medicare private insurance plans. If you find that that’s the case, you will need to call individual insurers and ask them how or even whether they would insure someone in your situation.
Charlene – Arkansas: I have federal health care and work for the post office. I plan to retire at age 66 and wonder if it would be better for me to just to keep my employee health insurance only and not take Medicare part B or have both after retirement?
Phil Moeller: I can’t answer your question because I don’t know your current health needs and certainly can’t predict what your future health costs will be.
Generally, getting Part B will improve the completeness of your health coverage. The question is, of course, how much coverage you might need and whether this benefit is worth the $134 a month that most folks now pay for Part B.
It can take some time, but one way to proceed here is to take some possible health events — cancer, for example, or joint replacement surgery, or an extended stay in a nursing home or hospital. Find out how your retiree coverage would work and how much having Part B would help. This is not easy to do, but it would help you make an informed decision about Part B.
Gia – Pennsylvania: An 82-year old friend of mine moved to the Republic of Georgia after her husband died so she could be near her children. She has very little money and, since she no longer needs Medicare, thought she could drop Part B and have its $134 monthly premium restored to her Social Security payments. Whatever she tried didn’t work, and now she has asked me to help.
Phil Moeller: If she has any printed record of when she first requested Part B cancellation, especially a copy of the withdrawal form she submitted, she should provide it to you. Establishing the earliest possible date for her withdrawal request is important in terms of qualifying for back payments.
I would then call Social Security on her behalf, explain the situation, and ask for assistance. I realize this sounds a LOT easier than the reality you may encounter.
If they decline to speak with anyone but her, see if your friend will agree for you to be her formal representative. She will need to sign a form.
Social Security is over-worked and under-staffed, but the people there generally try to be helpful. You need to be persistent.
Phil Moeller is the author of “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs” and the co-author of the updated edition of The New York Times bestseller “How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security,” with Making Sen$e’s Paul Solman and Larry Kotlikoff. On Twitter @PhilMoeller or via e-mail: firstname.lastname@example.org.