Medicare’s open enrollment period runs from Oct. 15 to Dec. 7 and now is the time for Texans with Medicare to check their health and drug coverage for 2019.
Open enrollment is the best time to make sure your health and drug plans still meet your individual needs, especially if you’ve had any changes in your health.
By now insurers should have notified you of any adjustments in your health or drug plan coverage or any changes in your out-of-pocket costs for next year.
Even if you’ve been satisfied with your health and drug coverage, you may benefit from reviewing all your options. Shopping around may save you money or improve your coverage.
Medicare Advantage remains a strong alternative for people who prefer to receive care through a private insurer rather than through Medicare’s original fee-for-service program. Most plans include drug coverage.
The number of people buying Medicare Advantage plans is expected to grow by 11.5 percent to 22.6 million nationwide in 2019. Thirty-five percent of Texans with Medicare now opt to get their health care benefits this way.
Many Advantage plans charge a separate premium on top of the Part B premium you’ll pay for Medicare’s medical insurance. Nationally, the average monthly cost for that separate Medicare Advantage premium will be $28 in 2019 -- $1.81 less than this year.
Texans in Medicare’s traditional fee-for-service program who want to add prescription drug coverage can choose from 27 drug plans with monthly premiums ranging from $10.40 to $140.10 – about the same premium range as a year ago. Nationally, the average premium for a basic drug plan in 2019 will drop by $1.09 to $32.50 per month.
Look beyond premiums, though. The only way to determine the true cost of your drug coverage is to consider other factors like deductibles, co-payments and coinsurance.
Medicare’s website – www.medicare.gov – has the best tool for helping you narrow your search for a new health or drug plan. Just click on “Find Health and Drug Plans.”
After entering your ZIP code and the list of your prescriptions, you can use the “Medicare Plan Finder” tool to compare your coverage and out-of-pocket costs under different plans.
The quality of a health or drug plan’s customer service should be considered, too. To help you identify the best and worst, the Plan Finder provides star ratings for each plan. The ratings range from five stars (excellent) to one star (poor); three stars are average.
Higher-rated plans deliver a higher level of care, such as managing chronic conditions efficiently, screening for and preventing illnesses, and making sure people get much-needed prescriptions. Higher-rated plans also have fewer complaints or long waits for care.
Besides using Medicare.gov, you can call Medicare’s toll-free help line at 1-800-633-4227 or consult your “Medicare & You 2019 Handbook,” which you should have received in the mail in the last few weeks.
One-on-one benefits counseling is also available through your State Health Insurance Assistance Program. In Texas, you should call 1-800-252-9240.
Medicare’s drug benefit continues to improve. You’ll enjoy more savings on your prescriptions. The “doughnut hole,” or coverage gap, will go away for brand-name drugs in 2019, which means you’ll receive a 75 percent break on those drugs after you pay your annual deductible and until you reach the threshold for catastrophic coverage, when you’ll pay substantially less.
The coverage gap for generic drugs will remain for only one more year and will kick in for you once you and your drug plan have spent $3,820 in 2019. At that point, you’ll receive a 63 percent discount on your generics – a bigger discount than this past year.
If you’re having difficulty affording your medications, you may qualify for extra help with your drug coverage premiums, deductibles and co-payments.
The amount of help depends on your income and resources. But, generally, you’ll pay no more than $3.40 for each generic drug and $8.50 for each brand-name drug in 2019.
Thirty-one percent of Texans with Medicare’s drug coverage now get such a break.
To learn more about whether you qualify for extra help, visit www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213.
There’s no better time to check your Medicare health and drug coverage. Any changes you make will take effect on Jan. 1.