Medicare Open Enrollment is here — do you have the right coverage?


One may have noticed recently an abundance of ads from TV to billboards for Medicare Advantage plans. This signals that Medicare Open Enrollment is upon us. From Oct. 15 through Dec. 7, all Medicare beneficiaries have the opportunity to decide which type of healthcare coverage they want for 2019. For many, this can be a daunting task given that there are more than 25 (yes, 25!) Medicare Advantage (MA) plans and prescription-drug plans to choose from in Philadelphia alone. But having some information and knowing where to get help can make this process a little easier to handle.

What exactly is Medicare Open Enrollment? It’s the time when beneficiaries can decide whether they are going to join a Medicare prescription-drug plan if they had not done so during their initial enrollment into Medicare. They can change their drug plan, too.

Beneficiaries can also change or enroll into a Medicare Advantage plan. These are private plans that offer all the services that Original Medicare A and B provide (i.e., hospital services, doctor visits), but might also include additional benefits such as vision and dental services. Most often, these plans have prescription coverage included. But do not be lured by marketing. It is important to understand the advantages and disadvantages of original Medicare compared to a private Medicare Advantage plan.  Any plan changes made during Open Enrollment take effect Jan. 1.

What kind of action does a beneficiary have to take? For those already enrolled into these types of plans, they should have received a notice in early October of the pending changes in coverage for 2019. It is important to remember that plans do change from year to year, so even if a beneficiary is happy with a current plan, a change could mean higher costs or new restrictions in 2019. If a member is OK with the changes, then he/she does nothing and keeps his/her current plan. But it might be worthwhile to explore other plans available in the market.

Consider the following:

Cost. Does the plan have a monthly premium? Is there a deductible to pay for health services or for prescription coverage? This defines what a member would have to pay before the plan starts paying for the service. What are the co-pays for services that a beneficiary might utilize most often, such as seeing a primary doctor, a specialist, lab work, physical therapy or medical equipment? Most Medicare beneficiaries are on a fixed income. Even though one cannot always predict future healthcare costs, it is worth considering the expenses that will accumulate from the services one already uses.

Coverage. When deciding on drug coverage, consider whether all the prescriptions are on the formulary. Does the plan require a prior authorization for a medication before it is dispensed? If considering a Medicare Advantage (MA) plan, which preventative dental or vision services are offered? What about more comprehensive dental services such as cavity fillings? Some MA plans also offer wellness benefits like discount gym memberships or nutritional counseling.

Convenience. When evaluating MA plans, beneficiaries should ensure that their health providers are in the plan’s network. MA plans have a group of contracted providers and it is in a member’s best interest to stay within that network to avoid higher costs or potentially risk not having that service covered.

Beneficiaries can also contact CARIE, the Center for Advocacy for the Rights and Interests of the Elderly at 215-545-5728. Our advocates are available to help answer questions related to Medicare, Open Enrollment and programs that help pay for Medicare’s out-of-pocket costs. Beneficiaries can also contact APPRISE, Pennsylvania’s Medicare healthcare counseling program at 1-800-783-7067. also offers tools to help consumers compare coverage options and plans. These programs are available for free with the goal of helping beneficiaries make informed choices for their future healthcare coverage. 

Mariel Lorenz is the CARIE LINE Supervisor at the Center for Advocacy for the Rights and Interests of the Elderly (CARIE).