What to Expect During Medicare Open-Enrollment

| Brittany McCullough
Medicare enrollment form

The open enrollment period (OEP) for Medicare officially kicked off on October 15. Plans started sending information about their offerings for the next year a couple weeks ago via the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC) as noted on CMS’s website. After looking at their plan’s offerings, beneficiaries can opt to change their coverage for health care and prescription drugs for the following year if they feel their plan won’t meet their needs.

So, what can we expect during this OEP?

According to CBS News, “more than 60 million seniors are expected to switch or renew their Medicare coverage.” One of the key questions for beneficiaries to answer when signing up for coverage is whether they want to be in traditional fee-for-service (FFS) Medicare or Medicare Advantage (MA). As I’ve previously discussed, MA plans provide the same coverage as traditional Medicare and additional supplemental services (more on that later) via private insurance companies.

Enrollment in MA continues to grow because of lower costs and more comprehensive benefits. The Trump Administration recently announced that on average, MA premiums are expected to decline by 23% and be the lowest in over a decade. Furthermore, CMS also announced that majority of Medicare beneficiaries will have access to MA and Part D plans with four or more stars. More specifically, the number of individuals enrolled in four- or five-star MA plans with prescription drug coverage in 2020 will increase by an estimated 12% from 2017. In addition, there will be 1,200 additional plans for MA beneficiaries to choose from for the 2020 OEP as compared to the 2019 OEP.

So, aside from more plan options, what other changes can one expect for MA plans in 2020?

MA plans will continue to expand access to supplemental benefits that are not “necessarily health-related but have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries. The flexibility to pay for things such as home air cleaners for individuals with asthma and transportation to the doctor should help keep people out the hospital. By reimbursing for non-medical items, CMS recognizes the vital role social determinants of health play in overall health status. This is particularly important for seniors with chronic illness, as unmet social needs can greatly increase chance for emergency room visit.

Earlier this year, CMS finalized a rule to increase the availability of telehealth services for MA plans beyond what is allowable under the traditional Medicare telehealth benefit. The additional telehealth benefits are the result of the Bipartisan Budget Act of 2018 and are expected to result in an estimated $557 million in savings over 10 years according to the rule’s summary of costs and benefits. One notable change in the additional MA telehealth benefits is the ability for the home to be considered an originating site, which will increase beneficiaries’ access to care from their home. In addition, access to telehealth will be available for individuals in urban areas as well as rural. Traditionally, Medicare has only allowed telehealth to be used in rural areas in which access issues are rampant.

Expanding the number of MA plans, increasing availability of telehealth, supplemental benefits, and plans with high-star ratings lends even more credence to a switch from traditional Medicare to Medicare Advantage. It will be interesting to see the final enrollment numbers at the conclusion of the OEP.

Check out URAC’s industry insight report, Charting a Path to Success in the Changing Medicare Advantage Landscape, linked here.

For more information on URAC’s Medicare Advantage Accreditation, click here.

Brittany McCullough photo

Brittany McCullough, Manager, Health Policy and Government Programs.

Brittany McCullough, URAC's Manager of Health Policy and Government Programs, tracks and analyzes legislation and regulations of importance to URAC stakeholders. She also helps manage URAC’s public policy external affairs portfolio and oversees compliance with government deemed programs. Most of her policy and research work has been related to the ACA, Medicaid managed care, Part D, telehealth and mental health parity. She holds a B.S. in Neuroscience and a Master of Health Administration.

Views, thoughts and opinions expressed in my articles belong solely to me, and not necessarily to my employer.

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