What's
new for 2019? Sometimes change is good
by Walecia Konrad |October 15, 2018
Medicare open
enrollment is full of moving parts, not least of which are government rules and
regulations that change each year.
Confusing? Sure. But
the welcome surprise this year: Most of the changes for 2019 are improvements
that will either save you money, improve your coverage, or both.
Here’s a quick guide
to the key changes coming to Medicare next year.
Cost increases will
be modest
Good news! Medicare
premiums are mostly holding steady or, in some cases, even dropping slightly.
The majority of
people with coverage under Medicare Part B for doctors and outpatient services will pay
$135.50 a month in premiums for 2019, just $1.50 more than last year, according
to the fee schedule announced by the Centers for Medicare & Medicaid
Services (CMS) right before the start of open enrollment.
Higher earners will
pay more, but even those premiums hikes are modest for all but those at the top
of the income heap. For instance, individuals who earn more than $85,000 a year
but less than $107,000 as singles (more than $170,000 but less than $214,000,
if you’re married) will pay $189.60 a month in Part B premiums, an increase of
$2.10, less than a cup of coffee in most places.
Above those income
levels, monthly premiums next year will range from $270.90 to $460.50. But you
have to be pretty well off to pay that top rate, which only applies to singles
making $500,000 or more, or married individuals with household income of
$750,000 and higher.
The increases for
deductibles are small too. For Part B, the annual deductible will be $185 in
2019, up from $183 this year. The deductible for hospital coverage under Part A
will rise to $1,364, vs. $1,340.
Meanwhile, the
premium for other types of Medicare coverage are actually expected to drop
slightly next year.
The average monthly
premium for Medicare Advantage, the private-insurance alternative to the
government-run program, will decline 6% to an average of $28 next year, vs.
$29.81 in 2018, according to CMS. This is on top of the premium you pay for
Part B coverage (and, in rare instances, Part A), which is included in
Advantage plans.
Plus, anyone who gets
prescription drug coverage via a Part D plan is also likely to pay less next
year. CMS reports that the average premium is expected to be
around $32.50 in 2019, about a dollar less than the current rate.
The dreaded donut
hole starts to disappear
The donut hole for brand-name prescription drugs will be
eliminated in 2019, a year earlier than originally scheduled under the
Affordable Care Act (ACA), thanks to the Bipartisan Budget Act of 2018. It will go away
for generic drugs in 2020.
That’s a big relief
for anyone on Medicare with significant prescription drug costs. Under the
current rules, you are on the hook for substantially more of your drug expenses
once the total costs of your prescriptions reaches a certain level ($3,750 this
year). Then when your out-of-pocket spending hits a second limit ($5,000 in
2018), catastrophic coverage kicks in and you pay substantially less.
In 2019, the coverage
gap for generic drugs will start once someone has reached the limit of $3,820
and ends when they have spent a total of $5,100. Overall, the net result of the
changes means that next year enrollees will pay 25% of the cost of brand-name
drugs, down from 35% this year, and 37% of the cost of generic drugs vs. 44% in
2018.
You’ll have a second
chance to get Advantage right
In 2019, if you
signed up for Medicare Advantage, you will now have an opportunity in the first three months of the year to switch to a different MA
plan or original Medicare, with or without Part D prescription drug
coverage. Under the more limited current system, there was a six-week
“disenrollment” period at the beginning of the year when Advantage enrollees
could drop their plans for original Medicare but could not switch between MA
plans.
“It’s
a good opportunity to kick the tires.”
Phil
Moeller, author “Get What’s Yours for Medicare: Maximize Your Coverage,
Mininmize Your Costs”
“This is like a special
open enrollment period just for Medicare Advantage,” says Phil Moeller, author
of Get What’s Yours for Medicare: Maximize your
Coverage, Minimize your Costs.
He says “It’s a good
opportunity to kick the tires.”
Some Advantage plans
will offer enhanced benefits
Under new government
rules announced earlier this year, Medicare Advantage plans will be able to
provide even more benefits beyond what
original Medicare covers starting in 2019. The new services could include adult
daycare, home-based palliative care, home health aides to provide personal
care, counseling and respite support for caregivers, non-opioid pain
management, memory fitness services, home and bathroom safety devices,
transportation to and from the doctor, and some over-the-counter health items.
Nearly 270 Medicare
Advantage plans, serving an estimated 1.5 million enrollees, will offer these
new supplemental benefits in 2019, according to CMS. Before you get too
excited, Moeller notes that’s just 7% of Advantage plan holders—for the
most part, the changes were announced with too little time left for insurers to
include them in their offerings for next year.
Nearly
270 Medicare Advantage plans, serving 1.5 million enrollees, will offer new
benefits in 2019.
Centers
for Medicare & Medicaid Services
Next year, however,
will probably be a different story. Bear in mind that even if you do find a
plan with expanded features, not all policy holders will necessarily be
eligible for all of the new benefits, Moeller says.
You’ll get more help
paying for some therapy
Currently, coverage
for physical, speech, or occupational therapy (often after suffering a fall or
a stroke or while managing a chronic illness) is capped at around $2,000 for
enrollees in original Medicare. As part of the 2018 budget deal, Congress eliminated
the coverage caps on those therapies starting next year.
If you want more
information about these changes or any other aspects of your plan, you should
be able to find answers in a document called the Evidence of
Coverage, which explains exactly what your plan covers and at what
cost and should have been sent out by insurers last month.
Meanwhile, all
Medicare recipients, whether they are covered under traditional or Medicare
Advantage plans, should also have received the newly updated Medicare and You handbook.
This outlines what Medicare does and doesn’t cover and explains several other
Medicare oriented rules and regulations.
If you have not yet
received this, call 1-800-Medicare to request another copy.
No comments:
Post a Comment