Open enrollment season for Medicare health and drug plans runs between Oct. 15 and Dec. 7. It’s when seniors 65 and older and younger Americans with long-term disabilities 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 choices enrollees face.
About 63.4 million Americans enroll in basic Medicare insurance, known as Parts A and B, according to the U.S. Centers for Medicare & Medicaid Services. Most are 65 or older, but nearly one in seven are younger with permanent disabilities.
About 37.5 million stick with this basic level of coverage, but that number has been declining as more opt for private insurance to deliver or supplement their Medicare coverage.
In Oregon, nearly 903,000 people are enrolled, up 2% from 2020. About 458,000 stick with this basic level of coverage.
Premium: Not yet announced. In 2021, most enrollees pay a Part B premium of around $148.50 a month, but in August a government report warned that cost could jump to $158.50. Higher income taxpayers (singles making more than $87,000 or couples earning more than $174,000) pay surcharges that in 2021 brought monthly premiums to between $207.90 and $528.90, depending on income.
Deductibles: Not yet announced. In 2021, the Part A hospital deductible was $1,484 per occurrence (Medicare Advantage enrollees pay no deductible but often are charged daily copays instead). The Part B deductible was $203, but a government report in August warned it could jump to $217 in 2022.
Enrollment periods: There’s a seven-month enrollment window that begins 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.
About 27.8 million, or 44% of eligible Medicare recipients nationwide, choose to have private insurers deliver their doctor and hospital coverage via Medicare Advantage plans, according to federal data. Most of these plans also offer prescription drug insurance, known as Part D. Medicare Advantage plans have become so popular that the number of people enrolled in only basic Medicare has declined since 2017, federal data show.
In Oregon, nearly 447,000, or about 50% enroll in Medicare Advantage.
Premiums: $0 to $211 per month in 2022 among plans in Oregon. That’s in addition to the monthly Medicare Part B premium mentioned above. Plans offered exclusively to Oregon PERS beneficiaries cost more. Most enrollees opt for a $0 copay plan, according to the nonprofit research organization Kaiser Family Foundation.
Enrollment period: Oct. 15 to Dec. 7
Roughly 24 million basic Medicare enrollees also buy a standalone prescription drug plan — coverage that basic Medicare doesn’t provide. They cover only medications, not care. Enrollment in these plans is down slightly overall.
In Oregon, 274,000 enroll in these so-called Part D plans.
Premiums: The government projects the average nationwide premium will be $33 per month in 2022, up nearly 5% from $31.47 this year. But actual premiums vary widely. In Oregon, Part D premiums range between $7.70 and $114.50 a month in 2022. Across all 24 plans in Oregon, the changes from the year prior ranged from a 38% decline to an 84% increase, according to The Oregonian/OregonLive’s analysis of federal data. High-income enrollees also pay a surcharge for Part D coverage that currently ranges between $12.30 and $77.10 per month.
Enrollment period: Oct. 15 to Dec. 7
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, copays and other cost-sharing requirements that basic Medicare doesn’t. In Oregon, nearly 178,000 buy Medigap coverage, down slightly from a year ago, according to the Oregon Department of Financial Regulation.
Premiums: $27 to $944 a month in 2022 in Oregon, depending on applicant age, health status and plan type, according to the Centers for Medicare & Medicaid Services.
Enrollment period: Only for 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 charge premiums based on an existing health condition.
New York and Massachusetts are two of only four states that allow continuous open enrollment, meaning insurers cannot deny coverage based on an existing health condition. Both states also prohibit Medigap policies from setting or raising premiums based on an enrollee’s age.
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 (In California, the birthday window is 60 days). This rule allows them to move to the same type of plan offered by another insurer. They can also move to a different type of plan with fewer benefits, such as from a Plan G to a Plan B. Seniors in employer-sponsored group Medigap plans are not eligible.
Online resource: Medicare.gov’s Plan Finder now offers an expanded search engine where consumers can get a better sense of the cost ranges of each type of Medigap plan based on their age and gender. Check it out at http://bit.ly/MedigapPlanSearch. You’ll also find a link to it near the bottom of the Plan Finder’s homepage. While it’s a good start, you might get better cost estimates from private health-insurance brokers or free counselors with State Health Insurance Assistance Programs (SHIPs). Oregon’s SHIP is the Oregon Senior Health Insurance Benefits Assistance program, or SHIBA.