Medicare enrollment options expand, giving seniors more to sort out

Oct. 18--Peter Boll, a retiree from Palm Beach Gardens, said he has received at least eight large mailers from insurers for options to sign up for Medicare coverage.

"I think the mailman got a hernia carrying them," Boll, 83, said. "It makes it hard for the average consumer."

Open enrollment for Medicare began Oct. 15 and ends Dec. 7, an important time for more than 4 million beneficiaries in Florida and about 55 million nationwide.

Hundreds of Palm Beach County residents are calling advisorsdaily for help to sort out expanded options. By Oct. 16, an agency providing free assistance to county seniors found itself booked up for appointments for telephone or in-person help through the first week of November.

"We definitely have more interest this year than last year," said Desirae Mearns, lead project director for Serving Health Insurance Needs of Elders, or SHINE, of Palm Beach County and the Treasure Coast. "It's been a whirlwind."

Seniors in Palm Beach County have 46 plan options in 2018 compared to 43 last year, she said. SHINE's office in West Palm Beach can be reached at 866-684-5885.

About half the questions her agency gets are related to traditional Medicare, and half are for plans managed by private insurance companies, known as Medicare Advantage, she said. For those choosing original Medicare, there are also prescription drug plans and Medigap plans they can buy.

Some callers, Mearns said, are asking about Medicare Plan F, which will not be available to new Medicare beneficiaries as of Jan. 1, 2020. Changes passed by Congress in 2015 will phase it out for new beneficiaries, though those already enrolled can keep it.

Plan F offers the lowest Medicare out-of-pocket costs among the standard options, though concerns were raised in Washington that it encouraged folks to go to the doctor for even minor issues without having to worry about paying something on each visit.

The average monthly premium for a Medicare Advantage plan will decrease, federal officials said.

The Centers for Medicare and Medicaid Services estimates that the Medicare Advantage average monthly premium will drop about 6 percent in 2018 from an average of $31.91 in 2017 to $30.

More than three-fourths, or 77 percent, of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium for 2018, officials said.

Medicare Advantage enrollment is projected to increase to 20.4 million in 2018, a 9 percent increase compared to 2017. More than a third of all Medicare enrollees, or 34 percent, are projected to be in a Medicare Advantage plan in 2018.

"The success of Medicare Advantage and the prescription drug program demonstrates what a strong and transparent health market can do -- increase quality while lowering costs," said CMS Administrator Seema Verma. "When Americans are empowered to choose the healthcare plans that fit their needs and the needs of their families, they demand more from their insurance plans and in turn healthcare plans, like any business, provide customers better service at a lower cost."

Still, the options place the burden on seniors to figure out which plan works best for them, based on how much care they expect to need, what prescription drugs they are using, and many other factors.

"This is becoming more and more complex," Boll said. "There are so many. It's hard to determine which would one to choose."

Staff writer John Pacenti contributed to this story.

14 things to know about Medicare Advantage Plans

1. You're still in the Medicare Program.

2. You still have Medicare rights and protections.

3. You still get complete Part A and Part B coverage through the plan.

4. Your out-of-pocket costs are typically lower in a Medicare Advantage plan so this option may be more cost effective for you.

5. You can only join a plan at certain times during the year. In most cases, you're enrolled in a plan for a year.

6. You can join a Medicare Advantage Plan even if you have a pre-existing condition, except for End-Stage Renal Disease (ESRD).

7. You can check with the plan before you get a service to find out if it's covered and what your costs may be.

8. Following plan rules, like getting a referral to see a specialist in the plan's network can keep your costs lower. Check with the plan.

9. Go to a doctor, other health care provider, facility, or supplier that belongs to the plan's network, so your services are covered and your costs are less. In most cases, this applies to Medicare Advantage HMOs and PPOs.

10. Providers can join or leave a plan's provider network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider.

11. If you join a clinical research study, some costs may be covered by your plan. Call your plan for more information.Get your plan's contact information from a Personalized Search (under General Search), or search by plan name.

12. Medicare Advantage Plans can't charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.

13. Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you'll pay nothing for covered services. Each plan can have a different limit, and the limit can change each year. You should consider this when choosing a plan.

14. If the plan decides to stop participating in Medicare, you'll have to join another Medicare health plan or return to Original Medicare.

Source: Medicare.gov

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