Dear Addy,

I am a Medicare beneficiary weighing my plan options for 2020. What do I need to know about choosing a plan for the coming year?

Medicare Beneficiary

Dear Beneficiary,

Every year Medicare open enrollment 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鈥檚 good you are starting your research now. Here are some important points to remember when choosing a Medicare plan.聽聽

What is Medicare?聽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.聽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鈥檛 cover).聽Important note for people with bleeding disorders:聽clotting factor (and new, non-factor hemophilia medication) is covered under Medicare Part B and聽not聽under the Part D drug benefit.

As an alternative to original Medicare, you can choose to purchase an 鈥渁ll-in-one,鈥 privately-issued聽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). If you opt for a Medicare Advantage plan, you cannot also have a Medigap supplemental plan.

What should I consider when deciding between Original Medicare and Medicare Advantage?聽Here are some of the considerations you might want to take into account:

What decisions do I have to make during Open Enrollment?聽If you currently are on a Medicare plan, you should review your provider鈥檚 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,聽2020. If you do not pick a new plan, you will be聽automatically聽renewed in your current coverage.

Those with traditional Medicare who purchased a Part D plan to cover their prescription drugs (remember, Part D does not cover injectable bleeding disorders products) may want to review their existing plan to ensure it continues to offer the best coverage. This is especially true if you have changed medicines in the past year. Further, health plans at times transfer drugs to different coverage levels from year to year, so do not assume your current coverage will be the same going forward. Medicare Advantage plans may also change from year to year, so it is imperative that you review your coverage under the private insurance companies that manage your plan.

Three new features to be aware of for 2020:

  • Updated CMS Plan Finder Tool. The Centers for Medicare and Medicaid Services (CMS) have made numerous changes to the Medicare website for 2020. For example, while the CMS website has retained some of its popular features, such as the ability to figure out costs for your Part D prescription drugs, you now will have to create an online account in order to save your inquiries and search results.
  • Medicare Advantage Plans Additional Benefits. CMS has worked to build some additional benefits into Medicare Advantage plans. These include, e.g.: telehealth services, transportation to doctor visits, additional coverage for over-the-counter medications, adult day-care services and other health care services that support health and wellness. There have been reports that Medicare Advantage Plans will not receive increased federal funding to support these benefits, however, so it will be critical that you pay attention to the services that are actually offered.
  • Changes to Medigap Plans. Medigap plans play a crucial role (for those insured under original Medicare) as supplementary coverage to assist in the payment of out-of-pocket expenses. One change that may be important to people with bleeding disorders: individuals who become eligible for Medicare benefits after January 1, 2020, will not be able to purchase any Medigap plan that provides 鈥渇irst dollar,鈥 full coverage of the Part B deductible. Individuals who already have one of these Medigap plans (i.e., Medigap Plan C or Plan F), however, may maintain this benefit. CMS is also allowing anyone else who was born prior to the year 1954 to continue their eligibility for this benefit even if they did not previously have a Plan C or Plan F, as long as plan issuers continue to offer such plans. While other beneficiaries will no longer have access to Plans C and F, they will be able to purchase other Medigap plans that cover all but about the first $185 of the Part B deductible.

You can find much more information about your Medicare options at聽, including via the government鈥檚聽Medicare Plan Finder聽tool. Your State Health Insurance Assistance Program (SHIP) is another helpful resource. You can find your local State Health Insurance Assistance Program鈥檚 (SHIP) contact information聽here.



Have a question? Click聽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 鈥淒ear Addy.鈥 Questions submitted to this column are edited in order to protect privacy and should be considered educational only, not individual guidance.


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