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From transportation to telemedicine, 2020 brings an explosion of fringe benefits to Medicare

San Diego Union-Tribune - 11/14/2019

After several years with relatively little change, Medicare beneficiaries have plenty to pore over this open enrollment season, which began Tuesday.

From now through Dec. 7, those age 65 and older get their annual chance to change their coverage, making fundamental decisions that will govern their health care experiences in 2020.

This year there are significant new options in Medicare Advantage plans.

Private health insurance companies intend to offer eight additional Medicare Advantage plans in the local market for 2020, bringing the total from 32 to 40. On the original Medicare side of the fence, where beneficiaries must purchase prescription drug coverage separately, the number of Part D plans will increase from 30 to 32 in the region.

Significant changes are also under way for Medicare gap insurance, also called "Medigap" coverage. (see "Minding the gap in Medicare insurance")

While there are several new companies offering coverage in the San Diego market this year, the most attention-grabbing change, and the one most likely to be marketed directly to you once open enrollment season hits its stride, is the explosion of "extra" benefits on offer among 2020 Medicare Advantage plans.

A change in federal regulations last year allowed carriers to expand extra benefit offerings, but only a handful of plans actually did so for 2019 coverage. This year, a review of 40 mainline plans, plus another 16 available only to those with special medical needs, shows significant changes.

Dental, vision and hearing coverage, none of which are covered under original Medicare, have been standard fare in Advantage plans for many years. Some plans also have added fitness clubs memberships as another perk designed to set them apart in a crowded field.

Recent policy changes also now allow plans to offer services such as:

Transportation to and from doctor's appointmentsBasic office visits using "telehealth" systemsHome safety modificationsIn-home supportive servicesCoverage of over-the-counter drugsEmergency-response devices that can warn loved ones and first responders of a fall in the home or other medical emergencyMedicare's Plan Finder website (see "Popular Medicare tool gets significant changes for 2020 open enrollment") shows that telehealth and transportation are the most popular among the new benefits. More than half of the plans available for 2020 in San Diego County list those two services.

Coverage for emergency response devices is also relatively popular with 17 out of 40 mainstream plans; over-the-counter drugs are also covered by a dozen plans. Only two carriers listed in-home supportive services among their offerings, and not a single carrier lists home safety modifications as a covered benefit.

There are, of course, many ways to view these new benefits. On one hand, they allow plans to fill long-standing gaps that often hinder effective medical care. And covering cooking classes for people who are trying to lose weight or rides to doctors offices for those who can't drive may also save the whole health care system money in the long run.

On the other hand, they tend to draw focus away, experts say, from what really matters: Premiums, deductibles and prescription drug coverage.

David Weil is program manager for the Health Insurance Counseling and Advocacy Program of San Diego and Imperial counties. (It's known as HICAP) He said fringe benefits have become a noticeable part of many seniors open enrollment calculations, but sometimes a single benefit can captivate at the expense of all else.

"Sometimes it's like, do you want to make sure your plan has a good trauma hospital that would save your life, or do you want to decide based on which gym you're going to go to for pilates?" Weil said.

Tatiana Fassieux, a consultant with California Health Advocates, said there is also a fair bit of monthly premium blindness.

Many Advantage plans get attention by offering a $0 monthly premium on top of the regular Medicare premium that everyone pays. But having eyes only for those zeros can have consequences, she said.

"People still go to the bottom line of zero or very low premiums; they don't look at the big picture," Fassieux said. "It's important that you look as far beyond that monthly premium as you can, and really ask yourself what it would look like if you actually have to use the coverage."

It's important to realize that all Advantage plans come with often-complicated systems of co-pays and deductibles. Every open enrollment, without fail, you should check to see what's changing in your plan. The government requires all plans to send printed change notices to each current enrollee and, while it's tempting to just slide that document right in the recycle bin, doing so is definitely a bad idea.

"These annual change notices are usually about 150 pages long, so they can be quite daunting and overwhelming for people," Weil said. "But you don't really have to read the whole thing. Most of the important changes will be listed in the summary at the beginning, so take your time and read, at least, say, the first 20 or 30 pages."

Pay special attention, he said, to changes in any plan's prescription drug coverage. Even if a drug you're taking is still covered, it could be shifted to a different "tier" that makes it more expensive for you to take. And plans can also charge more for getting your drugs from brick-and-mortar pharmacies than from online pharmacies that have lower overhead costs.

Armed with this basic understanding, you can look around at everything else that is available. If you find a deal, it's important, experts say, to return to the main core of coverage and ask yourself:

Does this plan include my doctor?Does this plan include the hospital I would want to go to if I got sick?What would this plan charge for all of the different drugs I'm taking?Checking his stuff out before the open enrollment window closes is simply good Medicare hygiene. And lucky for you, there is plenty of help out there.

Medicare's Plan Finder site, which has been significantly upgraded this year, allows you to compare plans side-by-side. There are also health insurance brokers and even free consultants funded by Medicare itself who can provide assistance free of charge.

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