Getting ready for 2019 Medicare Open Enrollment

October 7, 2019

By: The My Medicare Matters Team

The annual Medicare Open Enrollment Period (OEP) begins October 15th. You’ll have the opportunity to sign up for Medicare or change the plan you already have. As you prepare to take advantage of the OEP, information is your most valuable resource. Here’s a look at what’s changing and where you can turn for guidance.

What’s different this year

The biggest difference in Medicare this year is the Medicare Part D coverage gap—also known as the “donut hole”—has been closed. Sort of.

The gap refers to the out-of-pocket costs incurred by reaching a certain benefit threshold on medications. While that has been addressed recently, it doesn’t mean your medications will be free. Instead, Part D beneficiaries can expect a 25% copayment/coinsurance for drugs from the beginning of your plan year after meeting any plan deductible until you reach the 202 out-of-pocket spending limit of $6,350. After that, you’ll pay 5% of your drug costs. This limit is significantly higher than it used to be, and provides even more reason to shop around and compare prices. Switching plans can save you a lot of money on out-of-pocket drug costs.

Another drug-related change is the approved list of drugs your plan may cover. Both Medicare Advantage (MA) and Medicare Part D prescription drug plans may restrict coverage in very specific ways. For example, a prescription drug used to treat two conditions may be approved for only one condition under Part D. Make sure you understand what your plan will do.

If you have a chronic condition, there is a new category of supplemental benefits offered in Medicare Advantage plans. This new benefit can include anything the Centers for Medicare & Medicaid Services deems to have a reasonable expectation of improving or maintaining the overall health or function of enrollees with chronic diseases. Since this is a new feature and the benefit is not required to be offered uniformly to all chronically ill enrollees, you’ll want to ask about it before deciding on a Medicare Advantage Plan.

Last, but certainly not least, the Medicare Plan Finder has been significantly redesigned ahead of this year’s OEP. We can’t know many of the changes have panned out until OEP begins on October 15, but we’ll write about that in a future blog post. In the meantime, here’s what we had to say about it so far.

Where to look for more information

State Health Insurance Assistance Programs give you objective Medicare assistance for free. They help thousands of people each year, and we consider them an invaluable option for anybody seeking individualized help. If you’d like to contact them by phone, call 1-877-839-2675.

The annual OEP is also a good time to see whether you’re eligible for lots of other benefits. From help with prescription drug costs to utility assistance, our BenefitsCheckUp® tool provides an individualized look at hundreds of programs available in your area. You can even download some of the applications right from our site.