Dear Addy: Medicare Open Enrollment

Dear Addy,
I recently enrolled in Medicare and I got a notice that open enrollment for 2019 is coming up. What do I need to know about choosing my plan for the coming year?
Medicare Madness

Dear Medicare Madness,
You are right: Medicare open enrollment for 2019 is fast approaching! The open enrollment period for Medicare – this year and every year – runs from Oct. 15 through Dec. 7. This is the time of year when you can decide to stay with the Medicare plan you are currently on, or you can change to a new plan. Medicare has a lot of moving parts and can be confusing, so it’s good you are starting your research now. Here are some important points to remember when choosing a Medicare plan.   
What is Medicare? Medicare is a government health insurance program administered by the Centers for Medicare and Medicaid Services for individuals 65 years or older, and for individuals with a qualifying disability. Original Medicare includes hospital insurance (Part A) and medical insurance (Part B); you can also add prescription drug coverage (Part D) and Medicare Supplement Insurance (Medigap, which covers deductibles for Part A and B that original Medicare doesn’t cover). Important note for people with bleeding disorders: clotting factor (and new, non-factor hemophilia medication) is covered under Medicare Part B and not under the Part D drug benefit.
As an alternative to original Medicare, you can choose to purchase an “all-in-one,” privately-issued Medicare Advantage plan that covers all your hospital and medical services (Part A and Part B). Most Medicare Advantage plans also offer prescription drug coverage (Part D).
What should I consider when deciding between Original Medicare and Medicare Advantage? Here are some of the considerations you might want to take into account:

What decisions do I have to make during Open Enrollment? If you currently are on a Medicare plan, you should review your provider’s Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) to ensure that your plan will still meet your needs for the following year.
If your existing plan no longer best serves your needs, you can change your coverage during the Oct. 15-Dec. 7 window. You can switch among Medicare Advantage plans and prescription drug coverage (Part D); you can also switch from Original Medicare to Medicare Advantage, or vice versa, during this time. Your changes will take effect on Jan. 1, 2019. If you do not pick a new plan, you will be automatically renewed in your current coverage.
Two new features to be aware of for 2019:

  • As HFA previously reported, CMS changed its rules to allow Medicare Advantage plans to implement step therapy restrictions for Part B drugs, including clotting factor and other hemophilia therapies. A number of large national Medicare Advantage plans have announced that they will be rolling out step therapy restrictions for 2019 for at least a subset of Part B drugs. Patients who are already using a particular Part B drug will not have to switch; they will be able to continue using that drug, even if the plan adopts a step therapy protocol. Nonetheless, it’s still a good idea to carefully review your plan documents to see if there are any changes in your Part B coverage.

  • If you are ALREADY in a Medicare Advantage plan and find that it doesn’t serve your needs, next year you will a second opportunity to change to a different plan or switch back to Original Medicare during the period Jan. 1 – March 31, 2019.

You can find much more information about your Medicare options at, including via the government’s Medicare Plan Finder tool. Your State Health Insurance Assistance Program (SHIP) is another helpful resource. You can find your local SHIP’s contact information here.
Have a question? Click HERE. Your name will be changed in the response.
HFA frequently receives questions from the bleeding disorders community related to advocacy issues. The questions often impact the entire community. In an effort to reach the largest audience possible with our responses to these widely applicable questions, HFA developed “Dear Addy.” Questions submitted to this column are edited in order to protect privacy and should be considered educational only, not individual guidance.