Now is a great time to review your Medicare coverage


While Open Enrollment is still several weeks away, it is not too early to start thinking about reviewing your Medicare and Part D drug coverage.

The 2019 Open Enrollment period will begin this fall on Tuesday, Oct. 15 and end on Friday, Dec. 7. Any changes you make during this Open Enrollment period will take effect on Jan. 1, 2020. Although more changes may occur, there are several changes that have already been enacted by Congress that may impact readers.

Medigap Plans C and F have been eliminated. Medicare Supplemental Insurance plans, generally referred to as Medigap plans because they cover things such as deductibles not covered by Medicare Parts A and B, are sold by private insurance companies. In 2015 Congress enacted a number of changes to Medicare. Many of these changes received little notice at the time. For example, as of Dec. 31 of this year, Medigap Plans C and F are being eliminated.

Plan C policies provide coverage for Part B deductibles. If you currently have one of these plans it means you have very little out-of-pocket costs.

Plan F policies provide coverage for almost all deductibles as well as any Part B excess charges. An excess charge occurs when a Medicare provider does not accept Medicare assignment (what Medicare pays) or does not accept Medicare as payment-in-full for their charges.

According to the current Medicare rules, in such cases a provider may charge you up to 15 percent more than what Medicare allowed for the service. If you have a Part F plan, almost all of these excess charges are paid and you have practically no out-of-pocket costs to cover.

If you are currently enrolled in either of these types of plans, you may keep your coverage. In addition, if you receive a notice that your premium for either type of plan is being increased, you will still be able to shop around for a plan from a different company. But if you decided to enroll in a different type of Medigap plan you will not be able to re-enroll in Part C or F at a later date.

The goal of the 2015 legislation was to save the government money without placing an undue burden on enrollees. However, even if you are able to retain your Plan C or F coverage you will almost assuredly have more out-of-pocket expenses to cover. If you have a Medigap plan, or are considering purchasing such coverage, you do have to wait until Open Enrollment to purchase coverage. You can contact the Oneida County HIICAP program using the contact information listed at the end of this article to obtain help with your Medigap questions.

Closing of the Medicare Part D Donut Hole in 2020. While some may be negatively affected by the demise of the Medigap Plan C and F options, many will be pleasantly surprised to find that the infamous Donut Hole is finally closing. When the Medicare prescription drug program was created in 2003, Part D relied on two sections of coverage to pay for prescription drugs.

The first section is known as standard coverage or the coverage you receive through your Part D drug plan. This covers your prescription drug costs up to a set spending cap, which was set at $3,820 for this year. The next section is known as catastrophic coverage. In 2019 this section begins when you incur $5,100 in out-of-pocket drug costs.

The gap that begins where standard coverage ends and catastrophic coverage begins is known as the Donut Hole. For 2019, that gap amounted to $1,280 in costs that were not covered by your Part D plan. In other words, this year you could be on the hook for up to 100 percent of the $1,280 in non-covered drug costs.

Beginning in 2020, under The Affordable Care Act (the ACA) also known as “Obamacare,” the Donut Hole has been eliminated. In other words, beginning next year there is no longer a coverage gap. This elimination process has been a gradual one that began with the passage of the ACA. Beginning next year, the ACA will close this coverage gap for all generic drugs and reduce this copay to 25 percent as well.

In summary, next year if you meet the plan deductible you will pay no more than 25 percent of the cost of brand-name drugs. You will no longer fall into the coverage gap. The Donut Hole will become a thing of the past.

Medicare Card Scam. With the arrival of the Open Enrollment period comes the emergence of new types of fraud. The New York Senior Action Council is warning all Medicare recipients to be on the lookout for the “Medicare Card scam.” Individuals contact beneficiaries, usually by phone, claiming to represent Medicare and saying that you need a new Medicare card. They may threaten you with the loss of Medicare benefits if you don’t comply.

You will be asked to provide your personal information, particularly your Medicare number and bank account number, sometimes even being offered gifts or money. Keep in mind that Medicare cards do not expire and Medicare will not call you to request information. If you lose your Medicare card, contact Social Security and request a new one. If you receive this type of call, hang up. Better yet, if you have caller ID, do not answer the call.

Who do I contact in Oneida County for help? The Oneida County Office for the Aging/Continuing Care/NY Connects Health Insurance Information, Counseling and Assistance program (HIICAP) offices provide their services at no cost to Medicare beneficiaries. HIICAP offices are found at the following locations:

Copper City Community Connection, 305 E. Locust St., with hours of operation on Tuesday and Thursday from 10 a.m. to 2 p.m. While consumers are seen on a “first come, first served” basis, you may call the 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 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.


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