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By Brent Hunsberger | Special to The Oregonian/OregonLive
Open-enrollment season for Medicare health and drug plans runs between Oct. 15 and Dec. 7. It’s when seniors 65 and older can switch providers of their comprehensive health and drug plans. Other Medicare enrollees can also make changes. Here’s a guide to some of the basic choices enrollees face.
Basic Medicare
About 61.2 million Americans are enrolled in basic Medicare insurance, known as Parts A and B, according to the U.S. Centers for Medicare & Medicaid Services data. About 38.2 million stick with this basic level of coverage. In Oregon, nearly 860,000 are enrolled, up 2% from 2019. About 466,000 stick with this basic level of coverage.
Premium: Not yet announced. This year, most enrollees are paying around $135 a month, but the government has warned it could jump to $144. Higher income taxpayers (singles making more than $85,000 or couples earning more than $170,000) pay surcharges that likely will range between $202 and $490.50 per month in 2020, depending on income, according to the Medicare Trustees estimates.
Enrollment periods: There’s a seven-month enrollment window starting three months before the month you turn 65. Those who miss this initial enrollment period can sign up between Jan. 1 and March 31 each year. Those who are 65 and older and still working have eight months after employment ends or group insurance coverage terminates to enroll.
Medicare Advantage
About one-third of eligible Medicare recipients nationwide choose to have private insurers deliver their doctor and hospital coverage via Medicare Advantage plans, according to federal data. In Oregon, the rate is higher — 393,000 enroll, or 46%, one of the highest enrollment rates in the nation. Most of these plans also offer prescription drug insurance known as Part D. Medicare Advantage plans are becoming so popular that the number of people enrolled in only basic Medicare has declined over the past year, federal data show.
Premiums: $0 to $200 per month in 2020 among plans in the Portland market. Plans offered exclusively to Oregon PERS beneficiaries cost between $248 and $300 per month.
Enrollment period: Oct. 15 to Dec. 7
Prescription Drug Plans
Roughly 25.5 million basic Medicare enrollees also buy a standalone prescription drug plan — coverage that basic Medicare doesn’t provide. In Oregon, 274,000 enroll in these so-called Part D plans. They cover only medications, not care.
Premiums: In Oregon, Part D premiums will range between $13.20 and $120 a month in 2020. The government projects the average premium will decline for the third consecutive year, from $32.50 per month in 2019 to $30. But actual changes vary widely. Across all 27 plans in Oregon, the changes range from a 13% decline to a 28% increase, according to The Oregonian/OregonLive’s analysis of federal data. High-income enrollees also pay a surcharge for Part D coverage, which in 2020 is estimated to range between $12.60 and $78.90 per month.
Enrollment period: Oct. 15 to Dec. 7
Medigap
More than 14 million Americans opt for Medicare supplemental plans known as Medigap plans instead of Medicare Advantage plans. These policies cover Part A and B deductibles, co-pays and other cost-sharing requirements that basic Medicare doesn’t. In Oregon, 176,500 people buy Medigap coverage, according to the Oregon Department of Financial Regulation.Premiums: $26 to $480 a month in Oregon, depending on age and plan type, according to state data.
Enrollment period: Six months beginning the month a senior turns 65 or otherwise becomes eligible. After that, seniors can still buy a policy, but in most states, an insurer can, with some exceptions, deny coverage or price it based on an existing health condition.
Birthday rule: Oregon is one of only two states in which seniors can switch Medigap plans during a period that starts with their birthday and ends 30 days later. This rule allows them to move to the same type of plan offered by a different insurer or to a different type of plan with fewer benefits. Seniors in employer-sponsored group Medigap plans are not eligible.