What’s New for Medicare in 2019

By My Medicare Matters® Team | 1.3.2019

Medicare changes every year. Some of the changes like the expansion of the diabetes prevention program are narrow and impact a subset of Medicare beneficiaries, while other changes like the addition of the Medicare Advantage Open Enrollment Period impact a larger group of Medicare beneficiaries. Regardless of how big or small the changes are, as a Medicare beneficiary it’s important to stay up-to-date. Here’s what you should expect in 2019.

Increased Medicare costs

There will be various increases across the board for Medicare Parts A and B, including a 3 – 4% increase in Part A premiums, a 2% increase in the Part A deductible and copayments, and a 1% increase in Part B’s deductible and premium.

New Enrollment Periods

2019 will mark the return of a Medicare Advantage Open Enrollment Period (MA OEP), which provides additional opportunities to change your Medicare Advantage plan outside the Annual Election/Open Enrollment Period (October 15 – December 7). The annual MA OEP, which runs from January 1 – March 31 allows anyone enrolled in a Medicare Advantage plan on January 1 the opportunity to change plans.

There is also an individualized Medicare Advantage Open Enrollment Period that’s limited to new Medicare beneficiaries with both Medicare Parts A and B. These individuals have a three-month MA OEP to switch plans. Both the individual and the annual Medicare Advantage Open Enrollment Period allow Medicare beneficiaries already enrolled in a Medicare Advantage plan a one-time election or opportunity to either:

• Switch to a different MA plan, OR
• Switch from a Medicare Advantage plan to Original Medicare and a standalone Part D plan.

Medicare also added and made changes to several other special enrollment periods that you can learn more about in our Medicare Advantage: Special Enrollment Periods fact sheet.

Enhanced Medicare Advantage Benefits

Medicare’s 2018 Open Enrollment Period marked the beginning of ongoing changes to Medicare Advantage (MA) plans that include additional supplemental benefits designed to diagnose, treat, or prevent health conditions. In the past, MA supplemental benefits were required to be “primarily health related” and typically related to dental, hearing, or vision benefits. Now benefits can range from transportation services, meals deliveries, or even home and bathroom safety devices. These are just a few of the services that were included with plans during the Open Enrollment Period. Expect for more MA plans to be offering these services and more in 2019 and beyond.

Opioid prescription limitations

More than 17% of Americans had at least one opioid prescription filled in 2017, and it’s estimated that about 25% of them misused the medication. The opioid epidemic is impacting millions of lives every year, so preventive measures are being put in place on all fronts to reduce the impact. Medicare has joined the fight and created three new provisions that help identify and reduce the risk of older adults abusing opioids.

• Opioid prescription limitations and checks for all Part D enrollees – This requires Part D sponsors to limit initial opioid prescription fills for the treatment of acute pain to no more than a 7-day supply. Part D sponsors must also implement a flag at 90 MME (morphine milligram equivalent) per day, so when a beneficiary reaches that limit, the pharmacist must consult with the prescriber, document the discussion, and if the prescriber confirms intent, use an override code that specifically states that the prescriber has been consulted.
• Limitations on Part D enrollees considered “at risk” for prescription drug abuse – Part D plan sponsors must establish a drug management program for beneficiaries deemed at risk for prescription drug abuse. “At-risk beneficiaries” are identified as those who take a specific dosage of opioids and/or obtain them from multiple prescribers and multiple pharmacies. Plans may utilize a “lock in” provision to limit at-risk beneficiaries’ access to coverage of frequently abused drugs to a selected prescriber(s) and/pharmacy(ies) after case management with the prescribers and beneficiaries.
• Limitation of the Part D Special Enrollment Period for LIS and dual eligibles – This rule changes the Special Enrollment Period (SEP) for dual eligibles and Part D Low Income Subsidy (LIS) beneficiaries from monthly to quarterly during the first nine months of the year.

Part B step therapy

Medicare Advantage plans now have the option of applying step therapy for physician-administered and other Part B drugs. Medicare Part B’s step therapy requires enrollees to try one or more similar, lower-cost drugs to treat their condition before the plan covers a higher-priced medication. Plans requiring step therapy must offer drug management care coordination programs. Incentives such as gift cards may be offered to encourage participation in beneficiary engagement programs.

All of these changes took effect January 1. NCOA’s My Medicare Matters® will have several blog posts in the new year expanding on most of these topics.

https://www.ncoa.org/blog/whats-new-for-medicare-in-2019/?utm_source=newsletter&utm_medium=email&utm_campaign=01082019_NCOAWeek