Medicare’s fall enrollment period, which this year is Oct. 15 through Dec. 7, is a time for seniors to review their coverage and make changes for the coming year.
Whether you have traditional Medicare with a supplement to cover out-of-pocket costs plus a stand-alone drug plan, or a Medicare Advantage plan that wraps coverage together in one package, there are always small tweaks to plans that are worth reviewing. Plans may change which brands of drugs are covered, or which doctors are in-network, and you don’t want to discover that next year when it’s too late to switch.
Wading through the many plan options and features that become available every year is confusing no matter how much you know about insurance — and the relentless advertising by eager Medicare Advantage plans make it more so — but doing your research can pay off. This year, analysts say, people with Medicare should pay particular attention to:
A change to how some plans will cover insulin.
Whether you may qualify for financial assistance due to the pandemic-caused economic downturn.
“It’s gotten more complicated to be a Medicare beneficiary,” said Juliette Cubanski, deputy director of the program on Medicare policy at the Kaiser Family Foundation. “Even if you’re interested in shopping around, the burden of making the switch can seem greater than the benefits of doing so, but certainly when it comes to drug coverage alone, it can save people money if they’re willing to shop around.”
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Medicare Part D’s new insulin copay cap
Beginning in January, Part D prescription medication plans, which are purchased by people who have traditional Medicare, will be allowed — not required — to cap the monthly copay for insulin at $35.
In Pennsylvania, 10 of the 33 Part D plans available for 2021 will offer the insulin copay cap, as will nine of the 30 Part D plans sold in New Jersey. Some Medicare Advantage plans with drug coverage will also offer the insulin copay cap. If you are interested in this benefit, it is important to check whether it will be part of your 2021 plan, Cubanski said.
The change could be a money-saver for people who use insulin to treat Type 1 or Type 2 diabetes. Insulin costs for seniors who do not receive federal subsidies to help with medication expenses shot up 79% between 2007 and 2017, to $580 a year. Paying $35 a month could reduce annual spending to about $420, according to an analysis by the Kaiser Family Foundation.
But it’s important to consider the total cost of a drug plan before making changes, Cubanski said. Plans allowed to participate in the insulin copay program are “enhanced” plans, which offer more generous benefits, but also typically have more costly monthly premiums. If you take other medications, check that they are also covered by the plan. If they’re not, the amount saved on insulin could easily be consumed by other drug expenses.
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Are you eligible for a Medicare Savings Program?
Sarah Murdoch, a client services director for the Medicare Rights Center, said the New York-based consumer advocacy group is getting more calls about Medicare’s financial assistance programs during the pandemic.
Fall enrollment is a great time for everyone to check whether they are eligible for help — regardless of whether their income has been affected by the pandemic, she said.
There are several Medicare Savings Programs that help cover premium, drug, and health-care costs for people based on their income and assets.
The Qualified Medicare Beneficiary program, for instance, offers the highest level of assistance and is designed for individuals with a monthly income of no more than $1,084 and assets of no more than $7,860 in 2020. The Specified Low-Income Medicare Beneficiary program is available to people who earn too much to be eligible for the QMB program and helps pay Part B premiums.
“A lot of people are eligible for this and don’t realize it,” Murdoch said. “Especially now, when people are going through various hardships, [these programs] can be really helpful.”
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COVID-19 is limiting in-person support
If you typically visit state aging offices or other enrollment support organizations for help reviewing coverage options, Medicare enrollment specialists say it’s a good idea to give yourself extra time this year. Many of the in-person support services that seniors rely on are going virtual because of the pandemic.
“At this point, we are only doing virtual and phone assistance,” Natasha Alagarasan, a spokesperson for the New Jersey Department of Aging, said in an email. “The offices are preparing with the proper safety protocols for when in-person appointments are deemed safe to resume.”
Pennsylvania’s APPRISE program will offer counseling sessions by phone and through virtual appointments. In-person appointments will also be available at the discretion of local offices, said Susan Neff, director of Pennsylvania’s APPRISE program.
At the Center for Advocacy for the Rights and Interests of the Elderly (CARIE), fall enrollment is typically a busy time for in-person consultations with seniors. This year, CARIE, which is affiliated with Pennsylvania’s APPRISE program, is emphasizing telephone and virtual appointments and has spent the last several months working on ways to make the process easier for seniors who aren’t accustomed to using online platforms for meetings.
“We are trying to meet our consumers where they are, asking what technologies they have and what their comfort level is,” said Karen Chenoweth, who helps people review Medicare options through CARIE.
So far, the group has found success with the videoconference program Zoom. The group mails enrollment support materials to clients’ homes and encourages them to have handy any documents sent by their current insurer, so everyone can look at the same paperwork while reviewing coverage options together online.
“For the folks who do enjoy looking someone in the eye, we acknowledge that’s going to be difficult, but we hope people will be able to adapt,” Chenoweth said.
Get help with Medicare enrollment:
Pennsylvania APPRISE: 800-783-7067, or www.aging.pa.gov/aging-services/medicare-counseling
New Jersey Department of Aging: 800-792-8820, or nj.gov/humanservices/doas/services/ship
CARIE: 800-356-3606, or www.carie.org/