Be prepared for changes in Medicare, including premiums, in 2018

Published Nov 26, 2017 at 9:00am

Since we are in the Medicare Open Enrollment period, I want to look at Medicare for 2018.

At the time of this writing, we still do not know what the premiums will be for 2018. So, premiums and other related costs will be discussed as soon as the figures are released. 

Open Enrollment is well under way. The annual fall Open Enrollment Period started on Oct. 15 and ends Dec. 7.

You can enroll in or make changes to your Medicare Part D prescription drug coverage during this time. And, you can also review your Medicare coverage and decide between Original Medicare and a Medicare Advantage Plan.

The Oneida County HIICAP program is available every weekday to answer your questions or to assist in enrolling in the coverage of your choice during this period. 

• Extra Enrollment Opportunities for those Affected by Hurricanes and Wild Fires. Although New York residents were not directly affected by hurricanes Harvey, Irma, and Maria or the wild fires in California, many know people who were impacted by these disasters.

For these affected individuals, Medicare has created a special open enrollment period that extends Annual Open Enrollment from Dec. 7-31. If you have friends or family living in these affected areas, if needed they should call 1-800-Medicare to request the enrollment extension.

For those who were turning age 65 during these disasters, a Special Enrollment Period extension has been created that runs through May 31, 2018.

This extension is under the supervision of Social Security. For individuals whose initial enrollment was interrupted or impeded because of these major disasters, they should contact Social Security at 1-800-772-1213 or visit their local Social Security office to make enrollment adjustments for such weather-related events.

For individuals under age 65 who have experienced delays in enrolling in the Affordable Care Act health insurance plans, exemptions have also been granted. Individuals under age 65 should call the Exchange Call Center at 1-800-318-2596 to ask for more time to enroll in a plan. 

• Equitable Relief. The extra enrollment opportunities discussed above are made possible under an administrative process known as Equitable Relief. Equitable relief is most often applied when, through no real fault of their own, someone fails to enroll in Medicare Part B.

For example, your human resources department tells you that they will take care of your Part B enrollment when you turn age 65. If they do not follow through, under Equitable Relief you are eligible to enroll into Medicare Part B late but without a penalty. This doctrine has now also been applied to the Medicare Part D Open Enrollment Period. 

• Improvement in the Coverage Gap. One of the provisions of the Affordable Care Act was to gradually reduce the coverage gap or what many call the “donut hole.” Each year the donut hole is reduced until it will be eliminated in 2020.

For 2018, once you have met your annual deductible, you pay no more than 25 percent of the costs of your drugs until you reach the coverage limit of $3,760. At this point you enter the coverage gap or “fall into” the donut hole.

You remain in the coverage gap until your annual drug costs have reached $7,508.75. From that point on, catastrophic coverage begins and you will pay only 5% of the cost of your drugs.

For 2017, during the coverage gap period you paid 40 percent of the cost of covered name-brand drugs and 51 percent of the cost of generic drugs.

During 2018, those percentages will be reduced to 35 percent of name brand and 44 percent for generic drugs. In two years, there will be no coverage gap and everyone will pay 25 percent of the cost of all medications until they reach the point where catastrophic coverage, 5 percent cost share begins. 

• Changes in Part D Plans for 2018. According to the Centers for Medicare and Medicaid Services (CMS), there will be more choices in Part D Prescription Drug Plans (PDPs) over last year. But, there are no new plan sponsors. In fact, because of mergers we are seeing a decrease in the number of plan sponsors. So, you will see the same or fewer plan sponsors each offering more choices. 

The majority of PDPs use preferred pharmacy networks. Almost all use a five-tier cost sharing formulary. While the tier names change from plan to plan, the standard tiers are: (1) Preferred Generic, (2) Generic, (3) Preferred Brand, (4) Non-Preferred Drug and (5) Specialty Tier. The higher the tier, the higher the coinsurance or out-of-pocket costs you pay for each prescription. 

• Three Questions to ask when Reviewing your Part D Plan. After answering the most basic question “Are my drugs still covered?,” there are three important questions you need to ask:

(1) “Are any of my drugs in a different tier, with a different cost share?”;

(2) Do any of my drugs have new restrictions?” (this may be true if you are taking pain medications), and

(3) “Can I keep using the same pharmacies and are there any changes in the cost of using them?”

• Who do I contact in Oneida County for help with all my Open Enrollment questions?The Oneida County Office for the Aging/Continuing Care/NY Connects Health Insurance Information, Counseling and Assistance program (HIICAP) offices can answer all your Medicare and Part D questions. They provide their services at no cost to Medicare beneficiaries. HIICAP offices are found at the following locations:

• Ava Dorfman Senior Citizens Civic Center, 305 E. Locust St., with hours of operation on Tuesday and Thursday from 10 a.m. to 2 p.m. Again, while consumers are seen on a “first come, first served” basis, you may call the Dorfman Center at 315-337-1648 to see if there are long wait times.

• North Utica Senior Citizens Community Center, 50 Riverside Drive, Utica with hours of operation on Monday, Wednesday and Friday from 10 a.m. to 2 p.m. Consumers are counseled on a “first come, first served” basis. However, if you want to call ahead to see how busy the office is you may call the center’s HIICAP program at 315-724-8680.

• HIICAP services are provided by Oneida County Office for Aging and Continuing Care/NY Connects.

Anyone with questions about HIICAP, including issues with your Medicare Advantage Plan, should call the program directly at 315-798-5456 and press 4 in the choice list. It will direct you to someone who can assist you.

Dr. William Lane is the owner of William Lane Associates, a gerontological firm which located in Homer, NY. He writes a monthly column on HIICAP related issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.