Medicare open enrollment is live. Here’s what you need to know.

Open enrollment is underway for older and disabled adults who want to shop for Medicare prescription drug or managed-care plans for 2019.

Enrollment begins every Oct. 15 and will continue through Dec. 7. Changes are effective Jan. 1.

The Medicare Part D prescription drug plans and Medicare Advantage managed-care plans are available for everyone covered by Medicare, the federal health insurance program for people 65 or older and some younger disabled Americans.

Enrollees should review their coverage and make sure they still have the best plan to meet their current needs because plans and prices change yearly, said Chris Reeg, director of the Ohio Department of Insurance’s Ohio Senior Health Insurance Information Program (OSHIP).

“Just because it’s the best plan in 2018 doesn’t mean it will be the same plan in 2019,” Reeg said.

People should make sure the plan they choose is the most cost-effective option that also meets their needs, she said.

“Are your providers and pharmacies in network? We get a lot of phone calls with people saying, ‘Just give me the cheapest plan.’ In their mind, it’s cheapest premium. In our mind, it’s cheapest across the board” for potential out-of-pocket costs, Reeg said. “We want them to know about all possible costs before they sign up so they’re not blind-sided when they need care.”

Similarly, spouses need to review their plans individually and often have to pick different plans, said Francine Chuchanis, director of entitlement rights for Direction Home Akron Canton Area Agency on Aging, who reviews the Medicare Advantage plans offered in several area counties yearly.

Seniors need to do a personalized analysis on their own or with help at sessions from Direction Home or Check-Up Days from the Ohio Department of Insurance, Chuchanis said. That includes using the full list of prescription medications used by each person, she said.

“Different drugs cost different amounts in different plans,” she said.

Plan costs can sometimes have a substantial cost difference because it depends on the health of the individual and the prescription drugs taken, said Reeg.

The Medicare Part D drug plans are offered statewide; the Medicare Advantage plans vary by county.

The federal government contracts with private insurance companies to provide drug and/or medical coverage to Medicare recipients who sign up for the plans. Everyone but the poorest enrollees pays a portion of the monthly premium; the government picks up the rest.

For 2019, more than 2.3 million Ohio residents covered by Medicare can select from among 26 Medicare prescription drug plans, also known as Medicare Part D plans.

Nationally, enrollment in Medicare Advantage is projected to reach another all-time high of 22.6 million enrollees in 2019, an increase of 2.4 million or 11.9 percent from 20.2 million this year, according to the Centers for Medicare and Medicaid Services.

In Ashland County, there are 34 Medicare Advantage managed-care plans available that provide help paying for doctor visits, hospital stays and other medical services. All but three include prescription drug coverage.

Ashland County has seven more plans in 2019 than it did this year.

“Not just statewide, but nationally, we’re seeing an influx of Medicare Advantage plans coming into the market,” OSHIIP’s Reeg said.That’s because of some changes in Medicare guidelines, which used to require plans to have very distinguishable differences among plans.

That makes it more important for consumers to check the ins and outs of plans, what is covered, where you can go and what extra benefits may be offered, she said.

“You may find even though there’s more plans, they’re extremely similar,” she said.

In Ashland County, nine Medicare Advantage plans have no monthly premiums for enrollees; two of those plans do not offer prescription drug coverage.

Among the 26 Part D prescription drug plans in Ohio, the cheapest monthly premium is $14.50 a month from EnvisionRX Plus.

However, Chuchanis and Reeg both warn against simply choosing the cheapest plans without looking at other factors.

And unlike the old adage of “you get what you pay for,” there are many zero-premium Medicare Advantage plans with good coverage because Medicare pays plans to participate and subsidizes some costs, said Reeg.

But that still doesn’t mean the zero-premium plan is the cheapest overall, she said.

“We really encourage people to look at the maximum out of pocket” and figure out costs “if you have the worst-possible health year,” she said.

Both OSHIP and Direction Home offer workshops and phone consultations to help seniors research their choices.

“We don’t want any Medicare beneficiary feeling alone in this process. We also don’t want them picking their plan on the marketing plan that shows up in their mailbox. They’ll market a $0 premium, but they’re not going to market $400-a-day inpatient hospital (cost),” Reeg said.

Once seniors narrow down their choices, they also can talk to a representative from the company, who is usually on commission.

Seniors can enroll with a new plan by phone with the insurer, online at https://www.medicare.gov or through one of the workshops. Plans will auto-enroll if seniors want to stay on the same plan, but Chuchanis suggests still calling to confirm information and rollover enrollment.

Also, consumers should use Medicare’s quality star ratings, Chuchanis said. The ratings help people with Medicare, their families and their caregivers compare the quality of health and drug plans being offered. Managed-care and drug plans are given a rating on a 1 to 5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance.

In Ashland County, 15 of the 34 available Medicare Advantage plans for 2019 have a 4-star or higher rating. Akron-based SummaCare is the highest plan in Ashland County, achieving 4.5 out of 5 stars.

Additional reporting by Staff Writer Emily Morgan.

Local Medicare Information

- Ashland County will have a formal Medicare Education event at University Hospitals Samaritan on East Main Street in Ashland on Oct. 26. The presentation will begin at 10 a.m. followed by one-on-one counseling by appointment only.

- Enrollees can also contact Diane Cawood, an Ohio Senior Health Insurance Information Program (OHSIIP) coordinator, at 419-281-1477, to schedule an individual appointment for assistance, or call 1-800-Medicare.