IBM Medicare Via Benefits Medicare Insurance Change Still Possible

Although the Fall Open Enrollment Period ended in December.  There are still opportunities to make changes to your Medicare insurance during 2020. 
     

1. Medicare Advantage Open Enrollment Period: January 1 - March 31, 2020
        
   If you are enrolled in a Medicare Advantage plan, you are allowed to change to a different Medicare Advantage plan during the first three months of 2020.  If you find your current plan doctor network has significantly changed or the drug costs have significantly increase, you have options!  You can switch to another Medicare Advantage plan or you can drop into Original/Traditional Medicare (OM) and get a stand alone Prescription Drug Insurance plan (PDP).  The OM & PDP option might not be feasible in many states because there are varying rules from state to state on whether an insurance company is required to sell you a Medicare Supplement plan (aka medigap).  OM without a medigap that caps your out of pocket costs is a risky proposition.  Medical costs can rapidly escalate if you have a significant medical problem.
        
   
2. Medicare Plan Finder problems Special Circumstance Enrollment:  All year long
        
   Medicare, as in the government agency (aka CMS), has quietly issued a very significant admission statement in www.medicare.gov.  They know there were huge problems with their new plan finder program and have posted information on the website about allowing recipients to change their plans per the following link: https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances-special-enrollment-periods
        
   There is an important notice on that page titled "note":
        
   If you believe you made the wrong plan choice because of inaccurate or misleading information, including using Plan Finder, call 1-800-MEDICARE and explain your situation. Call center representatives can help you throughout the year with options for making changes.
        
   It's easy to overlook that note but the significance of it is huge!
           
3. There are other special enrollment conditions described on that same web page that can be life saving.  For example, if you move to a different zip code, you get a chance to totally change your insurance down to maybe being able to buy a medigap (check with your state to be sure of your options) because you are moving to a new zip code area.
        

My wishes for 2020 is you need none of the above and have the best Medicare insurance to meet your medical needs in 2020.  Happy New Year!

IBM Medicare Via Benefits part D structure 2020 & Kaiser Foundation & Medicare part D brochure information

In January 2020 the "doughnut hole" closes for generic drugs.
 
That means that in the second stage of drug plans, you will pay a 25% copay for the negotiated price of your drugs.  That might be more or less than you pay in the first phase.  The terminology for the second phase of "doughnut hole" has no meaning.  It started with there being NO coverage in the second phase in 2006 and that condition has gradually been remedied to where the second phase now provides policy holders with part D co-insurance coverage that approximates the first phase.
   
The pharmaceutical companies must still absorb the rest of the cost of the drug cost in the second phase.  For brand name drugs, they are not likely to do much negotiation with the insurance carrier to discount the drug because they will only be paid something less than 25% of the drug cost.  It depends on how many middlemen are involved that must also be paid.
 
There are two references in this post that will help you know more about drug plans and how they are structured.  The first, from Kaiser Foundation is a great analysis and also explains why there is such a big jump in out of pocket costs as policy holders move through the different phases.  There were provisions in the Affordable Care Act (ACA) aka ObamaCare that held down those costs.  Those provisions lapsed in 2019 and were not renewed by the current administration.
 
The second brochure is Medicare's attempt to explain the cost structure without getting too wonky.  It's a decent explanation.
 
https://www.kff.org/medicare/fact-sheet/an-overview-of-the-medicare-part-d-prescription-drug-benefit/
   
https://www.medicare.gov/Pubs/pdf/11109-Your-Guide-to-Medicare-Prescrip-Drug-Cov.pdf