Medicare Open Enrollment Time — Is It Time for a Change?

It is Medicare Open Enrollment time again and seems like a year passed fast, doesn’t it?

Every October it is time for family caregivers to assist their senior loved ones eligible for Medicare in determining whether they are getting the best insurance policy to protect their health and pocket book in the coming year.

Medicare open enrollment runs from October 15 to December 7. If your senior is already part of Medicare, it is time to look at their coverage to determine if it continues to meet their current needs and their potential needs in 2019, should there should be a change in their health status or medication list.

For many, no changes will be necessary but, for other seniors, tweaking the policy or adding a supplement to cover out-of-pocket Medicare expenses might be just what the doctor ordered.

But you won’t know unless you do a little research with and for them about what is in their best interest.

What Caregivers Should Know During Open Enrollment

Family caregivers want to support and guide their seniors to help them make the best decisions regarding their health insurance so they will continue to seek medical treatment when needed and be able to afford their medications.

Medicare participation is growing daily, as more older adults become eligible for this medical insurance program. There are currently 60 million seniors on the plan, with almost 10,000 more enrolling each day.

What do all the parts cover?

  • Part A covers hospital inpatient care, home health, skilled nursing care, hospice care
  • Part B covers outpatient care, home health care, medical equipment, doctor and other health care provider services (like therapists), routine vaccinations (flu, pneumonia)
  • Part D covers prescription drugs including shingles vaccine
  • Part C is Medicare Advantage which is a bundled plan that substitutes for Medicare Part A, B and D and includes things not covered by original Medicare such as vision, hearing and dental.
  • A Medicare Supplement helps to pay the out-of-pocket or coinsurance bills under original Medicare

It is important to know which services your senior now receives, what drugs they currently take, and what you foresee that they may need in the future. Will they need more home support, certain medical procedures, medical equipment, or home upgrades? Can they benefit by using more technology?

You can’t see into the future, but you may be able to anticipate some of their future or currently unmet needs to help determine if more or different insurance coverage would be beneficial or even essential. This is especially important for prescription drug coverage under Part D where there can be a wide difference in out-of-pocket expenses depending on the selected plan.

Family caregivers should read the information that was sent in the mail to their senior loved ones. It will help to answer questions and clarify any concerns. Caregivers can also check out the website to learn more including accessing the toolkits available to compare drug plans and Advantage plans available.

When looking at a Part D prescription drug plan, it is important to understand what drugs your senior is currently taking to pick the optimal coverage.

Examine the plans available and the coverage they provide across the board not just a few benefits for any unmet or future needs which may help the decision-making process clearer.

Remind your senior throughout the year to participate in all preventive health services fully covered under Medicare to be proactive about their health and avoid medical crises.

Changes in 2019

  1. Congress passed a spending bill in March that will close the donut hole in the Part D Prescription Plan for brand-name drugs in 2019. The gap closes for generic drugs in 2020.

This is good news for seniors with high cost medications who have had to pay out-of-pocket after a threshold was reached until a second amount was hit and coverage resumed. The donut hole was a financial obstacle for some older adults and resulted in medication adherence issues when monthly income couldn’t cover this cost.

  1. The cap on therapy coverage for outpatient services provided by skilled therapists – physical, occupational and speech, was repealed.

In the past, this cap could mean the cost of therapy had to be paid out-of-pocket by the senior (or family caregivers) or the therapy wasn’t provided, which could help seniors remain independent physically to remain at home to age in place.

  1. Improved resources to help seniors and family caregivers navigate the services beneficiaries will receive and tools to compare out-of-pocket costs as well as options to compare supplemental insurance plans available.
  2. In 2019 the services and reimbursement for telehealth/telemedicine will broaden so that seniors and family caregivers will be able to capitalize on the use of technology to receive medical care and treatment. Follow-up and monitoring of medications and vitals signs as well as virtual visits will be more accessible via telehealth.
  3. Medicare Advantage supplemental plans will be able to increase the services covered under their programs to include home delivered meals, transportation to medical appointments and home upgrades for safety. A medical provider must recommend these services before they can be received, but now they will be covered.

For seniors who have not opted for a supplemental health plan, this is one good reason to determine if the possible cost of coverage will be beneficial based on services now available and reduction in more out-of-pocket expenses traditionally paid by seniors and family caregivers.

  1. Medicare Advantage plans will also be allowed to pay for home health care, not just for medical treatment but also for help with daily tasks such as dressing, eating, and personal care.

Those Who Hesitate…

Family caregivers and seniors have time to consider the details but don’t let the time sneak up on you. You don’t want to miss the deadline for making changes which will benefit your senior.

When you help them evaluate the options, balance the cost of premiums against out-of-pocket expenses and drug costs to help them get the most for their money, a little tweaking now could give them a big payoff over the course of the year.