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Staying on Top of the 2020 Medicare Changes
By Daniel Casciato

Since President Lyndon B. Johnson signed it into law, Medicare has been the national health insurance program for U.S. residents 65 and older. In 1972 the coverage was extended to disabled Americans so it could also cover people under 65 with certain illnesses and disabilities. The program itself has many parts and can be quite complex with changing premiums, cost sharing and other details from year to year. It’s important to review changes to your Medicare plan each year, in order to be better prepared when 2020 arrives.

“While doing retirement planning it’s important to look at the costs of healthcare coverage and how to fund it,” says Bob O’Connor, Chief Medicare Officer for Aetna in Pennsylvania. “A person’s needs can be very different at age 65 versus age 81 so it’s important to reassess coverage from time to time especially as the products evolve. New coverages, different co-pays and changes in networks are just a few things to look at.” 

Here are some key things to consider:

  • When can I enroll or make changes?
  • Am I getting all the benefits I’m entitled to?  Can I qualify for a Special Needs Plan?
  • What hospital would I use if needed?  What would that cost?
  • Does the plan’s formulary (drug list) cover my medications? 
  • Are your doctors and pharmacy in-network in the product?  How is out of network handled? 
  • What are the plan’s out-of-pocket costs?  Copay vs. co-insurance?

(Review the premium, deductible, copays and/or coinsurance.)

  • Is a Medicare Supplement plan right for me? Which Part D Rx plan?
  • Do I need additional insurance for certain risks?

Know what your plan has to offer

“When you review your out-of-pocket costs, like plan premiums, don’t forget to factor in the cost of drugs and frequently used medical procedures,” says O’Connor. “These are expenses that get overlooked. The best thing to do is to discuss your coverage with a licensed broker or agent.  They have access to different companies” Many independent agents have tools that can determine eligibility for PACE/PACENET or other no-cost programs to help pay for prescription costs.  Other methods to gather information include calling the companies directly or using the internet, but it’s important to exercise caution when sharing personal information on the web.

The more you know, the more likely you are to get the plan that’s right for you, says O’Connor. For example, know if your doctors are in the plan’s network. Know if your plan requires you to have a primary care physician (PCP). O’Connor recommends you review all of your options, recognize what your budget will allow and understand what benefits you can expect to use each year.

“Some companies, or products within companies, differ in terms of network,” he says. “Understand which facilities, hospitals and doctors you want to be able to access. Make sure all of your doctors and hospital are in the plan's network – including the specialists. Consider a $0 premium plan – and bank the money.  Pay yourself instead of the insurer.”  He also recommends thinking out different scenarios.  “You are buying peace of mind so you want to make sure that you have access to world-class facilities should something really serious occur.”

O’Connor recommends comparing the plans supplemental benefits such as dental, vision, fitness membership and hearing aids. Some companies have added coverage for transportation, over-the- counter medications and post-hospital meals to ease the transition to home.

Some Medicare eligible people might qualify for a special needs plan based on income, chronic conditions or other factors.  Having an agent or carrier to check on this is important since those programs often offer extra enhanced benefits such as $4,000 annual dental coverage or $500 towards eyeglasses.

Is Medicare Supplement coverage the right choice for you?

“Medicare is a nice safety net, but it still has significant cost sharing, and some people might want help covering those significant costs,” says O’Connor. 

Once you have Original Medicare (Parts A and B), see if a Medicare Supplement plan is right for you. Although these plans work alongside your Original Medicare coverage, the premiums can be very expensive and will go up over time.  The plans also have deductibles and coinsurance that can be expensive. However, there are no network restrictions so you can use any physician or hospital that accepts Medicare and most medical costs are covered without cost sharing.

If you want to sign up for a Medicare Supplement plan, you can do so during the initial enrollment season. This is a onetime-only, 6-month period when federal law allows you to buy a policy you want that’s sold in your state. It starts in the first month that you’re covered under Medicare Part B, and you’re 65 or older. During this period, you can’t be denied a Medicare Supplement policy or charged more due to past or present health problems. If you miss this period, Medicare Supplement Insurance plans may check for medical conditions and your premium could be higher. 

When to enroll in a Medicare Advantage or prescription drug plan

The initial enrollment period for Medicare lasts for seven months — the three months before you turn 65, your birthday month and the three months following your birth month. You can sign up for Part A and/or Part B during that time. 

During your initial enrollment period, you can enroll in:

  • Part C (Medicare Advantage), with or without prescription drug coverage, once you have Medicare Part A and Medicare Part B
  • Part D (prescription drug coverage only) once you have Part A or Part B

Just remember, if you wait to enroll in prescription drug coverage, you may have a lapse in coverage and will have to pay a late enrollment penalty.

If you didn’t enroll during the initial enrollment period, or you want to select a new plan, you can do so during Medicare’s Annual Election Period. This begins October 15, and runs through December 7. However there may be other times when you may be able to join, switch, or drop a Medicare Advantage Plan. 

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If you’d like more information visit www.aetnamedicare.com.

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Their SNPs also have contracts with State Medicaid programs. Enrollment in their plans depends on contract renewal. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. 

©2019 Aetna Inc.

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