Medicare open enrollment begins Oct. 15. Here’s what you need to know

Akron Beacon Journal (OH)

Oct. 13--Open enrollment begins Monday for older and disabled adults who want to shop for Medicare prescription drug or managed-care plans for 2019.

Enrollment begins every Oct. 15 and will continue through Dec. 7. Changes are effective Jan. 1.

The Medicare Part D prescription drug plans and Medicare Advantage managed-care plans are available for everyone covered by Medicare, the federal health insurance program for people 65 or older and some younger disabled Americans.

Enrollees should review their coverage and make sure they still have the best plan to meet their current needs because plans and prices change yearly, said Chris Reeg, director of the Ohio Department of Insurance's Ohio Senior Health Insurance Information Program (OSHIIP).

"Just because it's the best plan in 2018 doesn't mean it will be the same plan in 2019," Reeg said.

People should make sure the plan they choose is the most cost-effective option that also meets their needs, she said.

"Are your providers and pharmacies in network? We get a lot of phone calls with people saying, 'Just give me the cheapest plan.' In their mind, it's cheapest premium. In our mind, it's cheapest across the board" for potential out-of-pocket costs, Reeg said. "We want them to know about all possible costs before they sign up so they're not blindsided when they need care."

Similarly, spouses need to review their plans individually and often have to pick different plans, said Francine Chuchanis, director of entitlement rights for Direction Home Akron Canton Area Agency on Aging, who reviews the Medicare Advantage plans offered in several area counties yearly.

Seniors need to do a personalized analysis on their own or with help at sessions from Direction Home or Check-Up Days from the Ohio Department of Insurance, Chuchanis said. That includes using the full list of prescription medications used by each person, she said.

"Different drugs cost different amounts in different plans," she said.

Plan costs can sometimes have a substantial cost difference because it depends on the health of the individual and the prescription drugs taken, said Reeg.

The Medicare Part D drug plans are offered statewide; the Medicare Advantage plans vary by county.

The federal government contracts with private insurance companies to provide drug and/or medical coverage to Medicare recipients who sign up for the plans. Everyone but the poorest enrollees pays a portion of the monthly premium; the government picks up the rest.

For 2019, more than 2.3 million Ohio residents covered by Medicare can select from among 26 Medicare prescription drug plans, also known as Medicare Part D plans.

Enrollment grows

Nationally, enrollment in Medicare Advantage is projected to reach another all-time high of 22.6 million enrollees in 2019, an increase of 2.4 million or 11.9 percent from 20.2 million this year, according to the Centers for Medicare and Medicaid Services.

In Summit County, there are 53 Medicare Advantage managed-care plans available that provide help paying for doctor visits, hospital stays and other medical services. All but five include prescription drug coverage.

That is 12 more plans in 2019 than this year with three companies -- CareSource, Meridian Care and Paramount -- new to Summit County and Humana's Cleveland Clinic plan extending outside of Cuyahoga County for the first time to include Summit, Lake and Lorain counties.

"Not just statewide, but nationally, we're seeing an influx of Medicare Advantage plans coming into the market," OSHIIP's Reeg said. That's because of some changes in Medicare guidelines, which used to require plans to have very distinguishable differences among plans.

That makes it more important for consumers to check the ins and outs of plans, what is covered, where you can go and what extra benefits may be offered, she said.

"You may find even though there's more plans, they're extremely similar," she said.

This year, for Summit County plans there have been minimal changes in premiums and coverage and the additional companies, said Chuchanis.

In Summit County, 19 Medicare Advantage plans have no monthly premiums for enrollees; three of those plans do not offer prescription drug coverage.

Among the 26 Part D prescription drug plans in Ohio, the cheapest monthly premium is $14.50 a month from EnvisionRX Plus.

However, Chuchanis and Reeg both warn against simply choosing the cheapest plans without looking at other factors.

And unlike the old adage of "you get what you pay for," there are many zero-premium Medicare Advantage plans with good coverage because Medicare pays plans to participate and subsidizes some costs, said Reeg.

Out-of-pocket costs

But that still doesn't mean the zero-premium plan is the cheapest overall, she said.

"We really encourage people to look at the maximum out of pocket" and figure out costs "if you have the worst-possible health year," she said.

Both OSHIIP and Direction Home offer workshops and phone consultations to help seniors research their choices.

"We don't want any Medicare beneficiary feeling alone in this process. We also don't want them picking their plan on the marketing plan that shows up in their mailbox. They'll market a $0 premium, but they're not going to market $400-a-day inpatient hospital [cost]," Reeg said.

Once seniors narrow down their choices, they also can talk to a representative from the company, who is usually on commission.

Seniors can enroll with a new plan by phone with the insurer, online at https://www.medicare.gov or through one of the workshops. Plans will auto-enroll if seniors want to stay on the same plan, but Chuchanis suggests still calling to confirm information and rollover enrollment.

Also, consumers should use Medicare's quality star ratings, Chuchanis said. The ratings help people with Medicare, their families and their caregivers compare the quality of health and drug plans being offered. Managed-care and drug plans are given a rating on a 1 to 5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance.

In Summit County, 23 of 53 available Medicare Advantage plans for 2019 have a 4-star or higher rating. Akron-based SummaCare and Canton-based Aultcare's PrimeTime are the highest plans in Summit County, each achieving 4.5 out of 5 stars.

Beacon Journal consumer columnist and medical reporter Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.ohio.com/betty

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