Medicare Open Enrollment Period: What You Need To Know

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Medicare Open Enrollment Period: What You Need To Know
Publication:
Riker Danzig Elder Law Client Alert October 15, 2019
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It’s the second most wonderful time of the year (the first being when the kids return to school): Medicare Open Enrollment Period.  This is the time of year when all Medicare beneficiaries make the critical decision as to whether or not to renew or change their coverage.  The reason why this timeframe is so critical is because Medicare Advantage and Prescription Drug rates and coverage change annually and it is wise to review and perhaps take advantage of those changes. This year the open enrollment period is from October 15, 2019 to December 7, 2019. Any changes made during the open enrollment period will take effect on January 1, 2020.

Medicare Advantage Plans and Medicare Supplements

The first critical choice is whether or not to enroll in a Medicare Advantage Plan or a Medicare Supplement Plan. With Traditional Medicare, Parts A and B, Part A covers hospitalizations and Part B covers medical visits. Part B has a projected monthly cost for most enrollees of $144.30 in 2020; for individuals with high income, the premiums will be much higher. It is a requirement to first be enrolled in Parts A and B in order to enroll for Medicare Advantage and Medicare Supplement Plans. With Medicare Supplements, you can go to any doctor or hospital that takes Medicare, anywhere in the U.S. With Medicare Advantage, in most cases, you’ll need to use doctors who are in the plan’s network.  Medicare Advantage Plans, which are sold by private insurers, offer additional benefits, including, but not limited to, prescription drug benefits, dental and vision services.

Starting in 2020, some Medicare Advantage Plans will offer additional benefits, such as home care, in-home safety services and rides to medical office visits.  These are services which have never been offered by these plans. This is why it is more critical than ever to take a look at the individual policies and determine which one is right for each individual situation.

Closing the Part D Donut Hole

In 2020, that gap where Medicare beneficiaries are responsible to pay for most of their Prescription Drug costs, known as the “donut hole,” will close and no longer exist. However, members will pay 25% of the drug costs and there will be an out-of-pocket limit for all medications, called the catastrophic threshold (2020 amount $6,350), that, once met, the Medicare beneficiary will be responsible to pay only a 5% co-pay. A Medicare Advantage Plan may assist with the required co-pays. 

Although there is no requirement that enrollees sign up for Medicare each year, with all of the changes, it is advisable to review your Medicare health and prescription drug coverage and make changes if your coverage no longer meets your needs or if you could reduce your out-of-pocket expenses.

In September, the "Plan Annual Notice of Change" (ANOC) was mailed out to all beneficiaries of Medicare coverage.  This notice indicates any changes affecting your plan coverage and should be carefully reviewed. 

This Alert was co-authored by Michael LaMagna, Partner of Riker Danzig (mlamagna@riker.com, 914.539.3365) and Michael Coogan of PGM Group (mcoogan@pgmgroup.com, 914.220.8333).