Have you seen all of the advertising for Medicare Plans?
It seems like the TV waves are inundated with commercials about Medicare this time of year. And there is lots of talk about new benefits, free benefits and low or no-cost plans. How do you sort out all of this information and determine what plan is best for you in 2020?
Medicare Advantage: Additional benefits, but not offered in Alaska
No doubt about it, we are in the middle of the Open Enrollment Season for Part D (Prescription Drug Coverage) and Part C (Medicare Advantage) plans. In Alaska, we do not have any Medicare Advantage plans available to the general public. Many of the commercials that you are seeing only concern those plans. These commercials are crafted quite carefully to attract the largest number of people so they will call for further information and assessment.
Some Medicare Advantage (MA) plans offer benefits beyond what Original Medicare, Part A (hospital) and Part B (medical) offer, such as routine vision, dental and hearing benefits. These are considered optional benefits. Some include prescription drug coverage. These benefits must be primarily health related and you may pay an extra premium. For example, if you would like dental coverage, you may pay more for that benefit. Some benefits such as a gym membership are “mandatory” which means that it is included in the Medicare Advantage plan and you may not exclude it from the cost. However, you can choose not to participate in the benefit.
Beginning in 2020, Medicare Advantage plans are allowed to offer additional, non-medical benefits such as meal delivery, transportation for non-medical needs, home air cleaners, pest remediation, and heart-healthy food or produce. To be eligible for these plans, you must meet certain criteria: You must be chronically ill, in other words, have at least one medical condition that is life-threatening or significantly limiting to your health or functionality. You also must have a high risk of hospitalization or other negative health outcomes and you must require intensive care coordination. Even if you meet the above criteria, it is up to the Medicare Advantage plan to determine if they will offer you any of the benefits. Some of the complex chronic conditions that are considered are: cardiovascular disorders, diabetes, chronic lung disorders, neurologic disorders, cancer, dementia, chronic alcohol or drug dependence, autoimmune disorders, stroke, end-stage renal disease (ESRD), severe hematologic (blood) disorders, end-stage liver disease, and HIV/AIDS.
Know your options
In Alaska we have Original Medicare, which includes Part A (hospital) and Part B (medical) coverage available. Once you join this coverage, you do not review the coverage each year. It generally remains intact as long as you continue to pay the premiums. Also available, to fill in the “gaps” of Part A & B, are Medicare Supplement plans, also referred to as “Medigap” plans.
Since 2006, Part D is also available. Part D plans are also known as “standalone” prescription drug plans. These plans are considered optional which means that if you have another form of creditable coverage (as good as Medicare coverage) such as Veterans pharmacy benefit, Indian Health Services, employer retiree coverage, or Tri-Care, you do not have to purchase Medicare Part D. If you are covered by any of these and you at some point choose to switch to Medicare Part D, you will not be assessed a late enrollment penalty (LEP).
However, if you are eligible for Part D (if you have Part A or Part B), you do not have creditable coverage and you do not choose a Part D plan, you will begin to accrue a late enrollment penalty (LEP). The penalty is accrued monthly and can add up to approximately $4.26 per 12 months you go without creditable coverage. When you do apply for Part D, the total will be added to your monthly premium each month and does not go away except for some special circumstances. During the October 15 – December 7 Annual Open Enrollment Period, if you have not yet applied for a Part D plan, you may do so. Your coverage will begin January 1 of the upcoming year. There are 24 plans available for 2020 from nine different companies. Even if you are quite satisfied with the coverage you have had this year, it is wise to review what is available for next year. To review your coverage, you can call 1-800-Medicare or the toll-free in Alaska number 1-800-478-6065.
Nila Morgan is a Certified Medicare Counselor who works at the Anchorage Senior Activity Center.
