Top 10 Things You Need To Know
Yes, there will be changes—but don’t worry. With our help,
you’ve got this.
1. During the Annual Enrollment Period (AEP) you can join, change or drop
(disenroll) from your Medicare Advantage HMO. You also can join, change
or disenroll from your stand-alone Part D prescription drug plan. The
changes will start January 1, 2019.
If you don’t make any changes, your current plan will simply roll
over on January 1. From January 1 through March 31, there will be a new
Medicare Advantage Open Enrollment period during which members can make
one change.
2. Open your Annual Notice of Change (ANOC) pamphlet as soon as you get
it. The ANOC is sent by your current Medicare HMO and/or Part D prescription
drug plan, and will arrive mid-September through October 1. If you’re
happy with your current doctors, your health plan and your coverage, you’ll
need to open the ANOC and examine any changes between your 2018 benefits
and the upcoming 2019 benefits. Health plans do change; confirm your physicians
and preferred hospital will still be available in your plan in 2019, and
whether your plan is adding or deleting any benefits. If you have Original
Medicare, you won’t get an ANOC, but you will get a Medicare and
You 2019 handbook—also around the end of October. It will explain
broadly how Medicare works, highlight any changes for 2019 and tell you
which services are covered by your Medicare plan.
3. Pay close attention to what the ANOC says about your prescription drug
costs. Your costs may not be the same in 2019 as they were in 2018. Be
especially aware if you are taking more expensive brand-name drugs. Some
might be moved to a higher “tier,” meaning they will cost
more. Some might be cleared for generic. Some people started to pay more
for their prescriptions later in 2018 because of entering the “coverage
gap” (AKA “the donut hole”), which means they have spent
a certain amount for covered drugs and are required to pay more until
the new year starts. The good news is the lower drug costs start over
again on January 1. But it’s likely you will enter the coverage
gap in 2019 about the same time as you did in 2018.
4. Consider changing to (or sticking with!) a Medicare Advantage HMO that
offers an array of options and is contracted by an independent provider
such as Torrance Health IPA (THIPA), especially if you are looking for
local access to a dedicated Member Service representative and the ability
to self-refer to specialists.
5. Pay attention to special coverage you might need or wish to have in
the future, such as routine vision, hearing aids, acupuncture, routine
chiropractic, discount dental and/or over-the-counter mail order benefits.
6. Check out the MOOP. MOOP stands for “maximum out of pocket.”
It’s one of the things that often changes in a new-year plan. Medicare
Advantage HMOs all have a MOOP, which typically ranges from $1,500 to
more than $3,400 each calendar year. MOOP is the limit of a member’s
copayments or coinsurance for any given year, and once it’s reached
you will no longer have to make copayments or coinsurance.
MOOP does not involve prescription costs—only medical services. MOOP
often becomes a concern for cancer patients because, in most cases, patients
with Medicare Advantage HMO pay 20% of their chemotherapy treatments until
they reach their MOOP for the calendar year. MOOP also becomes a concern
if a person stays in a skilled nursing facility longer than 20 days.
7. Do be careful when changing HMOs; it’s not a frivolous decision.
For instance, if you are changing to save a $20 copayment on an urgent
care visit with one HMO to another HMO with a $0 urgent care copayment,
you need to realize there may be another item where you might pay more.
Other benefits such as the mail-order option or outpatient mental health
benefits might be vastly different. If you are seeing a specialist or
acupuncturist or taking a brand-name drug, for example, they might not
be covered in the new plan.
Also make sure you are taking advantage of your current Medicare Advantage
HMO plan benefits. Are you really using the complimentary gym membership
benefit? Or the mail-order, over-the-counter benefits credit? Review your
policy details in the Evidence of Coverage (EOC) document, which arrives
in the ANOC mailing.
8. Torrance Memorial hosts live Medicare 101 classes, both on campus and
now online via Facebook Live. The classes are moderated by Norman Panitch,
MD, once a month and provide great detail on Medicare rules and options.
This is not only a good class for people new to Medicare but also a terrific
refresher course for anyone on Medicare. Visit THIPA.org for the schedule.
9. There are other times throughout the year you can make changes. If you
have been a bit overwhelmed by the decisions you need to make—say
choosing a physician or medical group or Medicare HMO—you still
can make one change between January 1 and March 31, the Medicare Advantage
Annual Open Enrollment Period.
There also are many Special Enrollment Periods, such as when you move out
of the service area for your HMO or experience a sudden drop in income.
Check with Medicare, your insurance company or your insurance agent anytime
throughout the year if you feel there is a need to change your insurance.
10. Medicare.gov is the official Medicare website and will be updated with
2019 insurance information by October 1. Medicare costs are typically
announced by the government in November. Medicare.gov is a convenient
way to shop for different HMO plans or stand-alone drug plans. You can
also call the insurance companies directly to request information, or
consult with an independent insurance agent.
What is Medigap?
Medicare Supplement plans (also known as Medi-gap), are offered by insurance
companies to help cover costs beyond Original Medicare Parts A and B.
These plans require you to pay monthly premiums and allow you to use any
Medicare participating doctor or hospital in the US. Premiums depend upon
age and extent of coverage, and you must also purchase a Part D prescription
drug plan. Combined monthly premiums typically range between $100 and
$300. To save on premiums, consider nonprofit THIPA, which is not a Medigap,
but charges no additional premiums and includes more than 500 excellent
South Bay doctors. To use an IPA such as THIPA, first sign up for an HMO,
then select a primary care doc who is with the IPA you want.
You can find help!
Medicare is tricky, and you want to make decisions you’ll be happy
with for a year.
For Medicare information call Torrance Memorial at 310-257-7239 or go to
medicare.gov or
medicareinteractive.org. For questions about THIPA please call 310-257-7239.
If you already are a THIPA member, contact your member services office
at 310-257-7250 and press 1 to speak to a representative. Or contact an
agent, such as Vince Kelly, 310-625-1837 (medicarebabyboomer.com), or Rose Straub, 310-715-2300 (ymainsurancesolutions.com) for a free consultation.
Or make an appointment for free Medicare counseling with a health insurance
counseling and advocacy expert, call Doris Herzog at 310-517-4666. Sessions
are held on Thursdays.