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Medicare Advantage Plan Changes for 2020 – Part C

Some of the best Medicare Advantage Plans for 2020 are from private health policies that offer a Medicare beneficiary an alternative way to get his or her Medicare benefits. Also known as Medicare Part C, Medicare Advantage Plans for 2020 are one-stop-shopping options that include hospital services, doctor visits, medical care, and prescription coverage in one package.

To be eligible for Medicare Part C, you must be enrolled in Medicare Part A and Medicare Part B. You are eligible for Medicare when you turn 65.

Overview of Medicare Advantage Plan Changes for 2020

Under new guidelines issued by the Centers for Medicare and Medicaid Services, Medicare Advantage Plans for 2020 can expand their supplemental benefits to give additional aid to individuals with chronic health conditions.

In 2019, Medicare Advantage Plans broadened their coverage to include medically related items such as wheelchair ramps and shower grips. In 2020, Medicare Advantage plans can extend coverage to include home improvements as long as the upgrades will improve or maintain a beneficiary’s overall function.

A Medicare Advantage Plan can also now offer benefits that will help reduce the cost of care, improve healthcare delivery, or enhance the quality of care. Examples include:

  • No copayments for individuals with hypertension who use lower-tier drugs
  • Reduced cost-sharing for individuals with congestive heart failure who participate in disease management programs
  • Copayment rebates for people with diabetes who undergo four annual preventive screenings

There are also several changes to the Part D coverage beneficiaries receive through Medicare Advantage Plans:

  • Plans must pay for opioid use disorder treatment services.
  • Plans must offer extra benefits that cover non-opioid pain management treatments.
  • Plans must offer at least one opioid-reversal medication.
  • Plans can now offer beneficiaries an auto-ship option for refills.

Best Medicare Advantage Plans for 2020: When Can You Enroll?

Medicare Part A and Part B beneficiaries can only enroll in a Medicare Advantage Plan or change plans during certain times. By signing up during these Medicare Advantage enrollment time frames, you will avoid gaps in coverage.

  • Medicare Initial Coverage Election Period ICEP: The Initial Coverage Election Period is when you are first eligible for Medicare Part A and Part B. It corresponds to your Medicare Enrollment Period, the seven months that start three months before your 65th birthday and end three months after your birthday.
  • Medicare Annual Election Period AEP: The Annual Election Period runs from Oct. 15 to Dec. 7 of each year. It is the best time to compare Medicare Part C plans for 2020 and find the one that best fits your needs. Any adjustments you make will become effective Jan. 1. During the AEP, you can join Medicare Advantage, switch between policies, or drop MA and return to Original Medicare. You can also add, drop, or change your Medicare Part D coverage.
  • Medicare Advantage Disenrollment Period MADP: The MADP was a six-week period that started on Jan. 1. The MADP allowed beneficiaries to drop their MA policy but stay enrolled in Medicare Part A and Part B. The Open Enrollment Period has replaced the MADP.
  • Medicare Advantage Open Enrollment Period MA OEP: During open enrollment, which runs Jan. 1 through Mar. 31, you can switch from one Medicare Advantage Plan to another. You can also drop Medicare Advantage and return to Original Medicare (with or without a Medicare Part D prescription drug plan).
  • Medicare Special Election Periods SEP: Special Election Periods allow you to change your health coverage outside of normal enrollment periods. Examples of SEPs include if you move outside of your plan’s service area or if your MA insurance company leaves the Medicare program.

Best Types of Medicare Advantage Plans in 2020

Private insurance companies offer Medicare Advantage Plans. Here are the main types of Medicare Advantage Plans in 2020:

Health Maintenance Organization HMO Plans for 2020

Nationally, 62 percent of Medicare Advantage enrollees are in an HMO. Here’s what you can expect from a Medicare Advantage HMO:

  • Has network for doctors, hospitals, and other healthcare providers
  • Requires primary care doctor (PCP)
  • Only covers in-network services (except in emergencies)
  • Requires referral to a specialist
  • Requires prior authorization for some services
  • Covers prescription drugs in most cases

Preferred Provider Organization PPO Plans for 2020

In 2019, PPOs account for 37 percent of MA enrollees nationwide. PPOs are more flexible than HMOs:

  • Has a provider network
  • PCP not required
  • No referrals needed from PCP
  • Out-of-network services covered but you pay a higher coinsurance
  • Rates typically higher than an HMO
  • Prescription drugs covered in most cases

Private Fee-for-Service PFFS Plans for 2020

Under a PFFS policy, the insurance company decides how much it pays and what your copayment and coinsurance amounts will be:

  • Might have in-network providers
  • Out-of-network services covered but cost more
  • PCP not required
  • No referrals needed from PCP

Special Needs Plans SNPs for 2020

Special Needs Plans usually are HMOs designed for individuals who need specialized care:

  • Dual-eligible for Medicare and Medicaid
  • Those living in institutional conditions
  • Those with specific chronic health conditions such as end-stage renal disease ESRD

Enrollment Figures for Medicare Advantage Plans

Over the past decade, Medicare Advantage has steadily become more popular with individuals eligible for Medicare Part A and Medicare Part B. Here are a few statistics about Medicare Advantage enrollment:

  • Number of beneficiaries opting for Medicare Advantage in 2019 compared to Medicare Part A and Part B: nearly 23 million (34%)
  • Medicare Advantage growth rate between 2018 and 2019: 8 percent (1.6 million)
  • Percent of Medicare beneficiaries who had a Medicare Advantage Prescription Drug Plan in 2018 compared to a stand-alone Part D plan: 42
  • Percent of enrollees who pay $0 premium: 56
  • Percent of beneficiaries enrolled in a 4- or 5-star rated Medicare Advantage Plan in 2019: 72

How do Medicare Advantage Plans in 2020 Cover Prescription Drugs?

In 2019, 90 percent of Medicare Advantage plans include prescription drug coverage. These are known as Medicare Advantage Prescription Drug Plans or MAPD plans. Before choosing an MAPD, carefully compare the drug benefits each one offers because they can vary greatly in several areas:

  • Formulary. The formulary is the list of drugs covered. Not all formularies cover the same drugs, so you need to make certain that the plan you are considering includes your medications.
  • Prescription Drug Tiers. Tiers are how the drugs are categorized. Typically there are between four and six tiers which range from generic drugs (least expensive) to specialty drugs (most expensive). Because each insurance company sets its tiers, your medication might be in Tier 3 in one formulary and Tier 4 in another.
  • Out-of-pocket costs. Coinsurance, copays, and deductibles will vary by plan, the insurance company, and drug tier.
  • Pharmacy restrictions. MAPDs might include a preferred network of pharmacies. MAPDs are allowed to change their networks during the year. That means your pharmacy could be dropped from the network.

In 2019, more than half (56 percent) of Medicare Advantage enrollees paid $0 premium for their MAPD. Among those who do pay a monthly premium, the national average is $65 a month. Even if the MAPD has a $0 premium, you must continue to pay your Medicare Part B premium.

Network Restrictions for Medicare Advantage plans in 2020

Unlike Original Medicare, Medicare Part C Plans typically have provider networks that beneficiaries must use. Here is a look at how Medicare Part C handles network rules:

  • In-network vs. out-of-network care within the service area. PPO Medicare Advantage plans cover services if you go out of network, whereas HMO Medicare Advantage plans usually do not except in emergencies. However, you will have a lower cost if you stay in the PPO network.
  • Traveling. HMOs and PPOs are required to cover emergency care if you travel outside of your service area. With a PPO, you have both in-network and out-of-network capabilities. In-network capabilities will depend on the network size.
  • Moving across state lines. Although a few PPOs have national networks, moving across state lines typically requires you to change policies. Moving out of your service area triggers a Special Enrollment Period for your new plan.

Added Benefits of Medicare Advantage Plans in 2020

In addition to the hospital, medical, and prescription coverage, Medicare Advantage Plans offer supplemental benefits not available with Original Medicare. Those extra benefits vary by plan and might raise your monthly premiums, but they are worth checking into. Popular supplemental benefits include:

  • Hearing
  • Routine vision and dental
  • Wellness programs
  • Diet and nutrition counseling

Remember, you cannot enroll in a Medicare Advantage Plan if you choose to have your health insurance covered through Original Medicare. Medicare Advantage Plans replace Medicare Part A and Part B.

However, you must stay enrolled in Medicare Part A and Medicare Part B to qualify for a Medicare Advantage plan in 2020. That means you must continue to pay your Part B premium.

Medicare Resources

If you would like us to help you compare plan options, benefits, and rates between Medicare Advantage Plans, give one of our licensed agents a call. We can also help you determine whether Original Medicare — combined with a stand-alone Medigap plan and Medicare Part D policy — or a Medicare Advantage Plan best fits your health insurance needs.

Here are a few other Medicare resources:
Where to Find Help with Medicare
Low-income Extra Help Program for Prescription Drug Costs
Social Security Administration
Why 2020 Will Launch the Medicare Advantage Boom in Home Care
U.S. Government Boosts 2020 Medicare Payments to Insurers by 2.53 Percent

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