Medicare Advantage changes

[lgelb]

Since Medicare open enrollment is happening through December 7, just a quick note on some 2019 changes that could affect your decisions. It is always worth looking at what you have vs. the competition every year. Not all counties have MA plans available if you are <65 or at all, but many do.

Original Medicare members no longer have a cap on SLP, OT and PT, though 20% coinsurance still applies.

But MA plans can now cover home health aides who help with activities of daily living, as well as meal delivery, transportation to medical appointments, grab bars, etc. if they are recommended by a health care professional. This doesn't mean all MA plans will add these benefits, just that they can -- so it may pay to compare.

Medicare Advantage members early next year can change MA plans or return to original Medicare if they don't like their MA plan. This has not been true in the past.

But note, there is no opportunity after December 7 for original Medicare members to change to an MA plan. So if you have always wanted to try a Medicare Advantage plan or find one that has new benefits you can use, as per above, you have 6 weeks!

You can find your plan options, plug in your drugs, etc. at medicare.gov.

Note that MA plans usually include drugs. Original Medicare does not, so you need a Part D (drug) plan as well. Also, MA plans can be a better deal than Medicare + Medigap + Part D, since there is an out of pocket limit that you don't have with original Medicare and its 20% coinsurance.

Disadvantages of MA plans can include less access to specialists (always join a PPO rather than HMO if you can for that reason), and a narrower range of providers, though networks can be quite robust as well (like everyone in a Blues plan), so again, it's worth shopping.

Anyone with individual questions, feel free to post or PM.

Best,
Laurie

 

[KimT]

Also, remember every State is different and every region within some states is different.

In Florida, the medicare advantage plans didn't pay the full 20% co-pay for durable medical equipment. The Medicare Supplement I have has paid the full amount of every co-pay since I got it in 2016. The only money I've paid is for my drug co-pay under Part D. There are different levels of Medigap (Medicare Supplement plans) with the richest ones being Plan F and G. In my case I got Plan G because it was cheaper (for people under 65) and the only difference was a small deductible (less than $200) at the beginning of each year. I've been to doctors all over the country, had physical therapy and even genetic testing. Medicare and my Plan G Supplement covered every penny of it. I never need referrals except for physical therapy.

The most important thing is to compare early. Don't deal with one company. If you need help, deal with a broker (it's free) and they can look at your situation and your medical needs and show you the pros and cons of each type of coverage and each plan within the types. I got the wrong information back in 2015 from a Blue Cross advisor regarding Florida Blue Advantage.

I suggest everyone look at both Advantage plans and Medicare Supplement plans every year and compare.

 

[Doglady]

Sorry, what is SLP? Thanks!

 

[Nikki J]

Speech language pathologist. At the top of this subforum is a sticky post that lists many of the acronyms we use here. It can get confusing for sure

 

[dldugan]

A reminder that the 12/7 date for enrolling or changing Supplemental and Part D plans is not far away. Laurie’s recap at top is good.