By Rick Banas of Gardant Management Solutions
A copy of the official U.S. Government Medicare Handbook for 2020 arrived in the mail at our house last week. The “Medicare & You” handbook is a publication of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid.
Information is provided on when and how you can sign up for Medicare and what steps are recommended, if you are already on Medicare, to prepare for 2020.
As the handbook notes, there are three parts to Medicare:
Part A – Hospital Insurance
Part A helps cover the cost of inpatient hospital care, skilled nursing facility care, hospice care and home health care. The handbook cautions that skilled nursing facility coverage is limited to individuals who require daily skilled care for the administration of intravenous fluids or medications or for physical therapy. Certification from your doctor is needed, and coverage usually only applies if the stay in skilled nursing immediately follows a qualifying three-day medically-necessary hospitalization. Medicare and most Medicare Supplemental Plans do not cover the cost of long-term care or custodial care for individuals with chronic medical conditions or a disability.
Part B – Medical Insurance
Part B helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, such as walkers and wheelchairs, and preventive services, including annual “wellness” visits and screenings.
Part D – Prescription Drug Coverage
If you want drug coverage, you also can join a separate Part D Plan. Part D helps cover the cost of prescription drugs. The Part D plans are run by private insurance companies that follow rules set by Medicare. While Part D is optional, there may be penalties if you do not sign up when you are first eligible.
There are two main ways to get Medicare:
Original Medicare includes Part A and Part B. You also can join a separate Part D Plan. The handbook states that under Original Medicare, you can go to any doctor or hospital that accepts Medicare, and in most cases, you do not need a referral to see a specialist. You usually will be obligated to pay a co-insurance amount of 20% of the Medicare approved amount for Part B services after you meet your deductible. There is no yearly limit to what you are obligated to pay out-of-pocket.
You also can buy a Medicare Supplemental Insurance Policy (Medigap) to help pay for your out-of-pocket costs such as the 20% co-insurance amount.
Under Original Medicare, you will pay a monthly premium for Part B. If you choose a Part D Plan, you will pay a separate premium.
Medicare Advantage, which also is known as Part C, is an “all-in-one” alternative to Original Medicare that bundles Part A, Part B and usually Part D. Your monthly premium may be higher under a Medicare Advantage Plan, but the plans may have lower out-of-pocket costs. Also, most Medicare Advantage Plans include extra benefits such as dental, hearing and vision.
In most cases, you will need to use a doctor that is in the plan’s network for non-emergency or non-urgent care.
While you cannot buy or use separate supplemental coverage, there is a limit on what you pay yearly for out-of-pocket costs.
Preparing for 2020
The big question as you look to the year ahead is what Medicare plan will still be the best plan for you in 2020. There may be changes to the current coverage, benefits and costs of your current health and drug plans that take affect in the new year. There might be other plans that better fit your needs, and plans that could lower your out-of-pocket expenses.
CMS suggests you take the time to compare your current coverage with other available options. If you are going to stay with your current health and drug coverage plans, there is nothing you need to do.
To compare your current coverage with other options, you can visit the Medicare Plan Finder website. If you would like personalized help with determining which plans would be best for you, contact your State Health Insurance Assistance Program (SHIP). There is no cost for the personalized counseling services available through SHIP. You can also call 1-800-MEDICARE (1-800-633-4227).
Oct. 15 to Dec. 7, 2019
If you already are enrolled in Medicare, you can change your Medicare health and drug plans during this time period. This includes going from a Medicare Advantage Plan to Original Medicare or going from Original Medicare to a Medicare Advantage Plan.
Jan. 1, 2020
If you make a change, this is when your new coverage begins. If you decide to keep your current coverage, this is the date that any changes to the plans’ benefits or costs will take effect.
Jan. 1 to March 31, 2020
If you are in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare. Individuals are limited to making one change during this period.
To locate the SHIP program in your state, click here.
For more information about Medicare, visit the official U.S. Government Site for Medicare website.