What you need to know about Medicare open enrollment

Medicare enrollees will have a flood of options to choose when open enrollment starts Monday and this year the privatized plans will come with three months to “test drive” the option.

Nearly 2.3 million people in Ohio are eligible for the federal health insurance program, including about 64,400 in Butler County and 35,700 in Warren County. Enrollees will need to decide by Dec. 7 whether to enroll in traditional Medicare or one of the many privatized options, known as Medicare Advantage plans.

This season, Medicare enrollees who choose a Medicare Advantage plan will also have from Jan. 1 to March 31 to change their mind and switch to another plan.

MORE: How to protect against Medicare fraud, predatory sales

Overwhelmed? The state gives free one-on-one help through the Ohio Senior Health Insurance Program, which can help you review coverage options. The plan that worked last year might not be the best option this year. The plan that works for one spouse might not be the best option for the other.

"Medicare open enrollment is the time that everyone on Medicare should review their health care and prescription drug plan to see if they need to make a change," said Chris Reeg, program director for Ohio Senior Health Insurance Program.

Reeg said people should review what the cost of a plan is, whether it provides the medical and prescription coverage they need and how convenient the plan is to use.

Seniors should keep an eye out for a letter from their insurance plan which will detail any changes coming next year to their current Medicare plan, Reeg said.

MORE: How Ohioans can get free Medicare sign-up help

About 66 percent of Ohioans get traditional Medicare, typically also with supplemental coverage. The other 34 percent have Medicare Advantage, which is a Medicare plan privately managed by a commercial insurance company.

Original Medicare is accepted almost everywhere and enrollees don’t have to worry about a network. Medicare Advantage plans have limited networks and those networks can change during the year after enrollment is closed.

On the other hand, Medicare Advantage plans tend to be less expensive and can come with additional benefits like dental and vision. Next year will be the first year that private Medicare plans can opt to pay for non-clinical benefits like adult day care and caregiver support services. The privatized Medicare plans also cap out-of-pocket expenses once enrollees have paid out to a certain limit set by the plan.

Don Mackos, president of Miamisburg-based Retired MediQ, which brokers Medicare plans, said in past years, open enrollment has been marked by disruptions like plans dropping physicians from their networks, but this year he’s mostly seen improvements in Medicare Advantage plans.

There’s more competition entering the area and prices are holding steady. Nearly 83 percent of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium in 2019, according to U.S. Centers for Medicare & Medicaid Services.

“Most of the changes we see with Medicare Advantage this year are improvements,” Mackos said.

He said the option for Medicare Advantage enrollees to make a change the first three months of this year will benefit customers and pressure insurance companies to provide good service and a good product or lose business.

“If, for whatever reason, you are on a Medicare Advantage plan and you want to make a change, you could just one time or go back to original Medicare,” Mackos said.

Another upcoming change is the early closing of part of the Part D coverage gap, sometimes called the “doughnut hole.” It’s a coverage hole where enrollees pay more for prescriptions after they reach a certain threshold until they pay enough to reach a second threshold, after which costs go substantially back down. The doughnut hold for brand name drugs closes in March and for generic drugs in 2020.

MORE: This new law means many more Ohio officials are watching out for elder abuse

Medicare enrollment season also tends to draw out scammers, so people should be aware of phone scams and other kinds of fraud. Any concerns about fraud can be reported directly to Medicare at 1-800-633-4227.

While enrollees might get advertisements in the mail, no one should be calling or knocking on doors and saying they are with Medicare or asking for any kind of payment. No one should be asking by phone for Medicare card information or social security numbers.

The only contact seniors should get will be from someone calling them back or contacting them about a scheduled appointment.

Medicare Check-Up Days

The Ohio Senior Health Insurance Information Program will hold free community events to help you make an informed choice for 2019 Medicare benefits. You can also get unbiased Medicare enrollment advice by calling the state program’s hotline at 1-800-686-1578.

Butler County

Fairfield Mercy Hospital Healthplex

3050 Mack Road, Fairfield

Oct. 25 10 a.m.

Counseling by appointment only. Call 513-603-8780 to schedule.

West Chester Activity Center

7900 Cox Road, West Chester

10 a.m. Oct. 29

Counseling by appointment only. Call 513-779-7360 to schedule.

Warren County

Otterbein Lebanon Lifestyle Community

585 Ohio 741, Lebanon

9 a.m. Nov. 1

Warren County Community Services

570 Ohio 741, Lebanon

9 a.m. Nov. 11

Counseling by appointment only. Call 513-695-2239 to schedule.


Medicare open enrollment season traditionally draws out scammers and predatory sales tactics. Here’s what you should know about what insurance agents can do and what sales tactics the Ohio Department of Insurance says are not allowed.

Insurance agents can:

• Distribute information and forms in a retail setting, at health fairs and promotional events.

• Travel to meet Medicare beneficiaries in their home IF they have been invited.

• Provide consumers information about public assistance programs and help individuals apply for government subsidies.

Insurance agents cannot:

• Send unsolicited emails or solicit door-to-door.

• Collect names, addresses and enrollment applications or conduct sales presentations at a health fair or promotional event.

• Sell products which are not health-related during a Medicare Advantage or prescription drug plan sales or marketing presentation.

• Provide meals at promotional and sales events.

• Sell products in health care settings (doctors offices, pharmacies, etc.).

Do not be persuaded by an insurance agent who tries to scare you into believing your Medicare rates are going to increase if you do not switch plans immediately.

If you believe you have been the victim of a deceptive sales practice, contact the Ohio Department of Insurance at 1-800-686-1527.

About the Author