Whether you’re new to Medicare or have been with the program for a while, it’s important to know how it works and what options are available to you. The federal insurance program has undergone many changes over the years, and even though this year’s changes aren’t major, the Medicare changes in 2019 are important to know and understand.
Before jumping into the changes, let’s briefly review the different parts of Medicare.
- Part A is hospital insurance. It’s there when you need inpatient care in the hospital or at a skilled nursing facility, hospice care, and/or home health care.
- Part B is medical insurance that covers services from doctors and other health providers including wellness checkups and outpatient care.
- Part D is prescription drug coverage.
While there is a part C—also called Medicare Advantage—it is offered through private insurance companies and can be a bundled plan of A, B, and D.
Below are a few of the most notable changes, some of which are minimal and no cause for alarm. Take some time to familiarize yourself with the new rules so nothing takes you by surprise in 2019.
Increased Medicare costs in 2019
Medicare Part A and Part B costs are higher—either in deductibles, copayments, or monthly payments.
- Medicare Part B now has a monthly premium of $135.50, up from $134 in 2018. The annual deductible is now $185, a $2 increase from 2018.
- Medicare Part A inpatient deductible is now $1340, up $24 from last year’s cost of $1,364.
- Hospital copays have increased from $335 to $341 for 61 to 90-day stays; stays lasting 91 to 150 days are rising to $682 (from $670 in 2018).
- You can also expect additional surcharges and income limits for high-income individuals on Medicaid Part B depending on the level of income.
Benefits for seniors
Seniors with original Medicare will see changes in the system as well
Congress permanently repealed the cap that limited some services, seniors no longer have to pay the full cost of physical and occupational therapy.
Another benefit is the closing of the “donut hole.” This is the coverage gap that requires seniors to pay out of pocket once a set amount of money has been spent on medications for the year. The remainder of costs for medication then has to be paid out of pocket by the individual. Under the Affordable Care Act, this gap was scheduled to close in 2020, but as a result of a bill passed in March by Congress, the brand-name prescription gap will close in 2019, but the generic gap will not close until 2020.
Seniors also now have the option to try the Advantage Plan without the commitment. If you have the Advantage plan, you’re able to switch to another plan or original Medicare if you don’t like it.
Medicare Advantage (Part C) has a new enrollment period
Enrollment for Medicare A, B and D still runs from October 15 through December 7.
Medicare Advantage now has a new open enrollment plan with a longer time to decide which plan to choose. In the past, the enrollment time ran from January 1 through February 14. Now, the enrollment period will last until March 31. If you decide that you want to switch plans, you are allowed to do that during this time.
If you have regular Medicare, check out the differences in plan options to see if you might receive more benefits you need under a Medicare Advantage plan. Many Medicare Advantage plans offer coverages not available with traditional Medicare such as dental, hearing, and vision.
Enhanced provisions for Medicare Advantage
Medicare Advantage’s coverage is expanded to include lifestyle support services. Examples of these services include home meal delivery, transportation to and from medical appointments, home safety fixtures, and assistance from home health aides who can help with daily activities.
New limits for opioids and other prescription drugs
And, 2019 rang in new limitations on opioid prescriptions. Medicare has put these limitations in place to help combat prescription opioid abuse across the nation. Limitations include requiring Part D sponsors to limit the initial prescription to a 7-day supply. Additional limitations are now in place for seniors deemed at risk for prescription drug abuse, such as people who have a certain dose and/or who obtain prescriptions for that medication from multiple prescribers. If there is a question, the pharmacy will contact the prescriber for verification.
Another change is in the Medicare Advantage plans for prescription medications. Step therapy will require seniors to first try one or more similar, lower cost medication before allowing a higher priced one to be filled.
In the end, the better informed you are about the changes to Medicare, the better prepared you will be.