Medicare Open Enrollment: What Changed in Response to the Coronavirus?

Q. I know that the Medicare Open Enrollment Period starts next month. Have there been any changes that I should know about in response to the coronavirus? Do you have any tips for Open Enrollment? This is my first one. Thanks for your help!

A. The COVID-19 pandemic has affected the United States for six months now, upending lives, society, the economy, and health care. The Medicare Open Enrollment Period is set to start October 15, 2020, with Medicare Advantage (MA) plans serving over 35% of Medicare beneficiaries. What, if anything has changed for this Open Enrollment as a result of the coronavirus? First, let’s take a look at what Open Enrollment is for you and others who are participating for the first time.

What is Medicare Open Enrollment?

The Medicare Annual Election Period gives you an opportunity to review and make changes to your current Medicare coverage. You can opt to:

  • Switch between Original Medicare (Parts A and B) and a Medicare Advantage Plan (Part C);
  • Change to a new Medicare Advantage Plan;
  • Change your prescription drug coverage (Part D) by switching to a new plan, dropping coverage, or enrolling in a plan for the first time.

Medicare Open Enrollment is a great time to review your Medicare plans’ coverage. If you have a Medicare Advantage plan or a Part D Prescription Drug Plan, it’s a good time to review your plan and re-enroll or enroll in another plan.

The upcoming enrollment period is designed specifically for people currently on Medicare to make changes for 2021. If you do not currently have a Medicare plan, you cannot enroll during this period. The General Enrollment Period (Jan 1-Mar 31) is for those who missed their Initial Enrollment Period and don’t qualify for a Special Enrollment Period. You may be assessed penalties for late enrollment. Finally, the Medicare Advantage Open Enrollment Period (Jan 1-Mar 31) allows people with a Medicare Advantage plan to change to a different Advantage plan or enroll in Original Medicare.

Changes for 2021

As the October 15 Medicare open enrollment period approaches, the Centers for Medicare and Medicaid Services (CMS) have announced a number of changes in Medicare procedures and coverage for calendar year 2021, some of which resulted from the coronavirus pandemic.

These are some of the changes for 2021:

  • Enrollment prohibitions have been removed for beneficiaries with End-Stage Renal Disease (ESRD) who choose to join a Medicare Advantage (MA) plan. Prior to 2021, patients with end-stage renal disease were unable to enroll in Medicare Advantage plans unless there was a Medicare Special Needs plan available in their area for ESRD patients. But that is changing for 2021, under the terms of the 21st Century Cures Act. People with ESRD have the option to enroll in Medicare Advantage for 2021, and CMS expects more than 40,000 to do so;
  • The establishment of new Special Enrollment Periods (SEPs) for exceptional circumstances.
    • For instance, on May 5, 2020, CMS announced that if you were unable to change your Medicare coverage during Medicare Advantage open enrollment or missed a different enrollment window because of coronavirus, you could have changed your coverage during a SEP that lasted until June 30, 2020. During this SEP, you were able to enroll in or change your Medicare Advantage or Part D coverage, or return to Original Medicare. Most people used this opportunity to enroll in Medicare, but you were also allowed to opt-out of Part B if you were automatically enrolled in it.
    • If your employer-sponsored coverage ended as a result of coronavirus, you have a SEP to join a Medicare Advantage or Part D plan or switch to a different plan. The SEP ends two months after your employer plan or COBRA ends. If you use this SEP, you can choose an effective date for Medicare Advantage or Part D coverage up to three months in the future. (You have to already have both Part A and Part B to enroll in Medicare Advantage.)
    • If you contract the coronavirus and are moved to a skilled nursing facility to recover, you have a SEP to enroll in a different Medicare Advantage or Part D plan or switch from an Advantage plan to Original Medicare. This opportunity to change your coverage lasts as long as you’re hospitalized and ends two months afterward.
  • CMS revised and improved the standard (“long”) model form used for MA and PDP enrollment to a new streamlined form.
  • Changes to the Electronic enrollment process to include new flexibility for Electronic Signatures.

For more details about updates for 2021, please click on this CMS guidance.

Preparing for Medicare Annual Enrollment

Understanding your health care expenses and coverage levels from this year will help you forecast costs for next year. It will also help you determine if it’s best to stick to your current plan or if a different Medicare plan would be better.

It’s also essential to be aware of any changes to current plans for next year. Knowing these changes will also help ensure that you enroll in the coverage you need for 2021.

To prepare for Medicare Open Enrollment, you should do the following:

  • Analyze this year’s costs: Understanding what you spent on health care this year can help you project costs for next year. As you think about how much your health plan costs, be sure to include the monthly premiums and all out-of-pocket expenses. While you’re evaluating this year’s costs, it’s also important to consider how well your current plan met your coverage needs. Think about these questions when analyzing current coverage:
    • Was there a drug or a service that you needed this year that wasn’t covered?
    • Is there a doctor you would like to see who does not accept your plan?
    • Does your current plan (A, B, Supplement, and D, or Medicare Advantage) continue to meet your needs and make the most financial sense?
  • Do your research: Medicare Advantage and Medicare Part D (Prescription Drug Plans) change every year. Additionally, companies offer new plans. There are a couple of important things to research about your current plan and for any new plan you consider:
    • changes;
    • new plans;
    • coverage;
    • cost-saving resources.
  • Review your Annual Notice of Change letter from your current Part D or Medicare Advantage carrier. You should have received this by mail this month (September). Look for what is changing that might affect you. Is the premium going up? Have your copays substantially increased? Are they dropping any of your important medications? If you find something you don’t like, then you have an opportunity to make a change during the upcoming Open Enrollment Period that begins on October 15th.
  • Make a list of all your current medications, including dosage and frequency. You can enter these into the Plan Finder Tool on Medicare.gov website beginning in October. This will help you to search for plans that you know will cover your necessary medications.

Medicare Doesn’t Cover Nursing Homes – Now is Also the Time to Plan for Long-Term Care

As we grow older, considerations towards our long-term care grow larger. More than two-thirds of us will need some sort of long-term care in the future, but Medicare will NOT cover the costs.

As many of you are aware, Medicare Part A provides coverage for short-term stays in skilled nursing facilities, but there is a huge caveat. The coverage is only for short-term rehabilitation for people who continue to improve, or for those who need skilled nursing care such as assistance with complex wound dressings, tube feedings, or rapidly changing health status. If you only require custodial care, such as help with bathing, dressing, and eating, that is considered long-term care and not healthcare, and is not covered by Medicare.

If you or a loved one is nearing the need for long-term care or already receiving long-term care, please call us to make an appointment for a no-cost initial consultation:

Medicaid Planning Fairfax: 703-691-1888
Medicaid Planning Fredericksburg: 540-479-1435
Medicaid Planning Rockville: 301-519-8041
Medicaid Planning DC: 202-587-2797

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