Nearly half of all new Medicare enrollees are signing up for Medicare Advantage plans, which now account for about 35 percent of the entire Medicare market.
The other 65 percent of Medicare beneficiaries are in what’s called original Medicare, which consists of Part A (hospital, nursing home) and Part B (doctors, equipment, outpatient expenses). Those patients usually have a private Part D drug plan, and a quarter have a private Medigap supplement policy.
Medicare Advantage (MA) plans must cover everything that original Medicare covers, and they can’t discriminate against people who are ill or have preexisting conditions. Anyone, regardless of their health, can get an MA plan or switch to one during open enrollment, which continues through Dec. 7.
FOR MOST OF US, MAKING the move from private, employer-provided health insurance to Medicare is a daunting task. First, there’s the new lexicon: Medicare Advantage, Part B, Part D, Medigap – what do they mean? Then there’s the fear: “The Medicare decisions you’re about to make will affect your health care and out-of-pocket costs for the rest of your life,” says the Medicare information organization 65 Incorporated.
Yikes – that’s a lot of pressure! Take a deep breath, because with some research and careful consideration, you can find a Medicare plan that works for you. Here are the steps you should take to make the right choice.
1. Check your timing. “Timing is one of most important decisions a person can make,” says Diane Omdahl, co-founder and president of 65 Incorporated. Many people need to enroll during the Initial Enrollment Period, which is the seven months surrounding one’s 65th birthday – including the three months before, your birthday month and the four months after. Patients may be responsible for late penalties and lapses in coverage if they don’t qualify for a Special Enrollment Period, which allows you to enroll outside your 65th birthday window or during open enrollment, for unplanned events like losing a job and associated health insurance coverage.
CMS is seeking comments on an interim final rule that increases payments to suppliers for some DME and enteral nutrition in areas of the country that are not subject to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DEMPOS) Competitive Bidding Process (CBP). These include rural areas, and Alaska, Hawaii and the territories. From June 1 through December 31, 2018, payments will return to the blended rates that were in effect in 2016.
The change is in response to stakeholder concerns about significant financial challenges created by the current rates for suppliers, as well as concerns that the number of suppliers in certain areas continues to decline. It is projected to result in a $70 million dollar Medicare cost-sharing increase to beneficiaries. This increase may be covered by supplemental insurance programs like Medigap, and for dual eligible beneficiaries, Medicaid pays the cost sharing. However, beneficiaries who do not have supplemental insurance or who are not dual eligible will have increased cost sharing.