Health & Spirit

You've got questions about Medicare's 2020 fall enrollment period. We've got answers.

Sarah Gantz, The Philadelphia Inquirer on

Published in Health & Fitness

Medicare's fall open enrollment, which runs from Oct. 15 through Dec. 7, is an opportunity to review your benefits and make changes in time for 2020.

But signing up or reviewing your coverage can seem daunting.

Last year, we asked Philadelphia Inquirer readers what they'd like to know about Medicare, and brought an excellent list of questions to a panel of experts. For 2020, we've updated our primer on Medicare with new details you should know:

Q: What's the difference between traditional Medicare and Medicare Advantage?

Traditional Medicare is managed by the federal government and offers coverage for hospital services (Part A) and outpatient services, such as primary care doctors, specialists, and routine care (Part B). Medicare Advantage plans are run by private insurance companies approved by the federal government. These managed-care plans must cover all the same benefits as traditional Medicare (though you'll be limited to their provider networks), but may offer extras, such as dental, vision, or hearing services.

Q: I like my plan and in 2019, it covered the medications I needed -- do I need to do anything during the fall enrollment period?


Open enrollment is a time when any current or new Medicare beneficiary can sign up for a plan or switch plans. You can switch from traditional Medicare to Medicare Advantage or vice versa, change your prescription drug plan, or pick a different Medicare Advantage plan. (A supplement plan that begins after age 65 might be more expensive, however, because of underwriting practices.) People with Original Medicare may buy a standalone Part D prescription plan, while Medicare Advantage plans typically include prescription drug coverage.

We heard a lot about prescription drug costs in the news this year, with President Donald Trump's call to require drug companies to include prices in their television ads and several proposals in Congress to address rising prices. But little has actually changed about how drugs are covered under Medicare.

But each plan's drug formulary, the list of covered medications, varies by plan and will change every year, so it is important to make sure the plan you have is still the best fit. Formularies rank medications into tiers, with lower-tier drugs the preferred and least-expensive options. Higher-tier versions of the same medication will cost more. Health plans frequently switch their preferred choices and may even drop medications from the formulary. Even if your drugs are still on the formulary, the plan may have changed how they're covered. They might limit the amount you can order or require prior authorization before filling the prescription -- which is not guaranteed to be granted.

Q: How do I know which plan is right for me?


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