Health Insurance HQ: An Update on the Health Care Landscape | Actors Fund

Health Insurance HQ: An Update on the Health Care Landscape

Welcome to Health Insurance HQ—coming to you from the experts at The Actors Fund's Artists Health Insurance Resource Center and special guests!

Dear Friends,

Medicare Open Enrollment is coming up; there are a few things you need to know.

Fall Open Enrollment runs October 15 through December 7, 2019 and is the time of year when you can make changes to your Medicare coverage. Any changes you make will take effect on January 1, 2020. Take action to make sure your coverage will meet your needs in in the coming year.
Know the changes you can make during Fall Open Enrollment

 The changes you can make include:

  • Joining a new Medicare Advantage Plan or Part D prescription drug plan
  • Switching from Original Medicare to a Medicare Advantage Plan
  • Switching from a Medicare Advantage Plan to Original Medicare (with or without a Part D plan)

 Review your coverage for 2020
If you have Original Medicare, visit or read the 2020 Medicare & You handbook to learn about Medicare’s benefits for the upcoming year.

Medicare Advantage and Part D plans usually change every year. Make sure that your drugs will still be covered next year and that your providers and pharmacies will still be in the plan’s network. If you have a Medicare Advantage Plan or a stand-alone Part D plan, read your plan’s Annual Notice of Change and/or Evidence of Coverage (EOC).

What are some things I should consider when choosing a Part D prescription drug plan?
Ask yourself the following questions before choosing a Part D drug plan:

  • Does the plan cover all the medications I take?
  • Does the plan have restrictions on my drugs (i.e. prior authorization, step therapy, or quantity limits?)
  • Prior authorization means that you must get approval from your Part D plan before the plan will pay for the drug.
  • Step therapy means that your plan requires you to try a cheaper version of your drug before it will cover the more expensive one.
  • Quantity limits restrict the quantity of a drug you can get per prescription fill, such as 30 pills of Drug X per month.
  • How much will I pay for monthly premiums and the annual deductible?
  • How much will I pay at the pharmacy (copay/coinsurance) for each drug I take?
  • Is my pharmacy in the plan’s preferred network? You pay the least if you used preferred network pharmacies.
  • Can I fill my prescriptions by mail order?

You may find it helpful to use Medicare’s Plan Finder tool, which gives you a list of Medicare Advantage and Part D plans, the drugs they cover, and their estimated costs for the year. You can access Plan Finder by going online at or calling 1-800-MEDICARE.

What are some things I should consider when choosing a Medicare Advantage Plan?
Ask yourself the following questions before choosing a Medicare Advantage Plan:

  • How much are the premium, deductible, and coinsurance/copay amounts?
  • What is the annual maximum out-of-pocket cost for the plan? This amount may be high, but can help protect you if you have expensive health care costs.
  • Are my doctors and hospitals in the plan’s network?
  • What are the rules I have to follow to access services and medications?
  • Does the plan cover additional health care benefits that are not covered by Original Medicare?

Medicare Advantage Plans usually include prescription drug coverage. You should also consider the questions listed for Part D in choosing a Medicare Advantage Plan to make sure that the prescription drug coverage that the plan offers meets your needs.

If I switch to Original Medicare during Fall Open Enrollment, can I purchase a Medigap policy to help with cost-sharing gaps?
Medicare supplement insurance policies, commonly called Medigaps, offer standardized benefits to supplement Original Medicare (not Medicare Advantage). They are sold by private insurance companies. These policies pay part or all of certain cost-sharing “gaps” that remain after Original Medicare pays first. Depending on where you live, you may be able to purchase a Medigap policy during Fall Open Enrollment, but certain limitations apply as to who can buy a Medigap and when. It is important to contact your State Health Insurance Assistance Program (SHIP) to learn about Medigap enrollment rights in your state before you make your Open Enrollment choices. To find your SHIP, call 877.839.2675 or visit

Will I have opportunities to change my coverage in the coming year?
You should make any necessary changes to your Medicare coverage by December 7, 2019 in order for the changes to take effect January 1, 2020.

In 2020, you may have the opportunity to make changes if you have a Medicare Advantage Plan. You’ll be able to make one change to your coverage between January 1 and March 31. This enrollment period is only for people who are enrolled in a Medicare Advantage Plan, not for those enrolled in Original Medicare.

Protect yourself from marketing violations and enrollment fraud

During Fall Open Enrollment, there is a higher risk than usual for fraudulent activity. Medicare has rules about how plans can and cannot communicate with you. Plans are allowed to send you mail, but are not allowed to call, email, or visit you in person without your permission. Watch out for people who pressure you to join their plan, tell you they represent Medicare and want to offer free services, or inform you that you will lose your Medicare benefits unless you sign up for a certain plan!

Contact your Senior Medicare Patrol (SMP) if you receive any notices that seem suspicious. SMP representatives can teach you how to spot and protect yourself from potential Medicare fraud. Visit or call 877.808.2468.

Yours in good health,

Debbie Kraus
Health Benefits Specialist

Do you work in performing arts and entertainment and have questions about health insurance? The Actors Fund provides assistance nationally. Contact our regional office closest to you to speak to a counselor.

New York City

Los Angeles

Don’t forget to use the resources section of our website. It contains tools to help you make decisions about your health insurance, including new online tutorials on how to choose providers and how to read an Explanation of Benefits. In addition, you’ll find an updated Stage Managers National Health Directory, our national online directory of health care providers recommended by industry professionals that can be used by theaters and touring companies. For these resources and more, visit You can also find out more about enrollment assistance and upcoming health insurance seminars near you!