If you’re covered for health insurance by Medicare, then you may have already noticed some important changes that are taking place – primarily improvements – with your benefits. If so, that’s because there were several “upgrades” made to Medicare’s coverage for 2019.
Depending on which type of Medicare you are covered under (i.e., Original Medicare – which is Medicare Part A and B – or Medicare Advantage), these improvements are designed to help enrollees to receive better coverage, pay less for items and services – or both!
Starting with Original Medicare, there are several updates of note that can make both getting your coverage – as well as understanding it – much easier. First, if you’re enrolled in Medicare Part A and B, then you will no longer be required to pay the full cost of outpatient services you receive, such as:
Why? Because the “cap” that had traditionally limited Medicare’s coverage for these services has been lifted.
If you are willing to communicate with your doctor(s) and / or other health care professionals via phone or online, then the broader availability of telehealth programs for Medicare enrollees may be of interest to you, as well.
Through “telehealth” programs, patients can now chat with a doctor, nurse, and / or other health care workers without having to physically go to an appointment. Starting in 2019, Medicare will start to cover telehealth programs for those who are receiving treatment following a stroke, as well as for those who have been diagnosed with ESRD (End Stage Renal Disease).
In 2019, Medicare has also made it a point to provide better communication overall. This, in turn, can help enrollees to have a clearer understanding of benefits, as well as to determine which coverage options are the best for their specific needs.
For instance here, the Medicare handbook sent to enrollees every year in the fall has been updated to include more flowcharts and checklists. These can help people narrow down the right benefits, as well as get a better understanding potential out-of-pocket expenses, based on the coverage options that they choose.
If you are enrolled in Original Medicare, you may want to add a cost safety net that can help with the payment of various Medicare deductibles, copayments, and / or coinsurance amounts. This can be done by purchasing a Medicare Supplement plan.
Medicare Supplement insurance – also known as Medigap coverage – is sold via private insurance carriers, as versus through Medicare itself. As of 2019, there are ten policy options to choose from. These are all labeled by letters of the alphabet, starting with Plan A (which offers a basic set of “core” benefits).
While Medicare Supplement policies offer essentially the same coverage that they offered in 2018, there are some proposed changes going forward. For example, starting on January 1, 2020, Medicare Supplement Plan F will no longer be offered to new enrollees. The same holds true for Medigap Plan C. These are currently the only two Medicare Supplement plans that provide coverage for the Medicare Part B annual deductible.
If you are already enrolled in either of these two plans, you can still keep your coverage and you won’t be forced to cancel your plan and purchase a different option.
In order to purchase any of the Medicare Supplement insurance policy options, there are several parameters you must meet. This includes being enrolled in both Medicare Part A and Part B.
If you are covered by Medicare Part A and B, it is likely that you also have a stand-alone Medicare Part D plan that helps you with paying for your prescription medication. If so, then you may have noticed that there are some nice changes to these plans, too.
One of the most costly elements of Medicare prescription drug plans is the “donut hole.” This refers to Part D enrollees who have high medication costs being required to pay more for their prescriptions once they have reached a certain level of spending for the year.
This Part D coverage “gap” is commonly referred to as the Medicare Part D donut hole. If you had fallen into the donut hole in the past, you likely know that after your out-of-pocket spending reached a second “threshold,” you would then enter into the plan’s catastrophic coverage where you would pay much less for your prescriptions for the remainder of that year.
Based on provisions that were set forth through the Affordable Care Act (aka Obamacare), the donut hole was set to disappear in the year 2020. But the March 2018 spending bill that was passed by Congress moved that deadline up to 2019 for name brand drugs.
For generic medications, the Part D donut hole is still set to close next year. According to the Kaiser Family Foundation, there will be more Medicare Part D prescription drug plans to choose from going forward.
Not to be left out, Medicare Advantage (which is also commonly referred to as Medicare Part C) has also added some updates that can make this form of Medicare coverage easier to understand from both a benefit and a cost standpoint.
It is estimated nationwide, there are roughly 3,700 Medicare Advantage plans to choose from now. This represents a significant increase over the number of plans that were available in 2018.
One of the biggest changes that you will see here is the ability to “test drive” a Medicare Advantage plan. As of 2019, based on regulations that were set forth in the 21st Century Cures Act, you are allowed to essentially try out a Medicare Part C plan – and, if you find that the particular plan is not a good fit for you, you can switch over to a different Medicare Advantage plan, or alternatively, you can go back into Original Medicare (Part A and Part B) coverage.
Other Medicare Advantage improvements of note include a plan’s ability to pay for home health aides, and the option of coverage for transportation, meal delivery, and various safety features installed in your home.
With these benefit additions, Medicare Advantage plans will now have the option of paying for assistance via home health aides who can help individuals with basic daily living activities, such as eating, dressing, bathing, and other personal care needs. This benefit essentially expands Medicare Advantage coverage beyond that of only health or medical related needs.
Starting in January 2019, Medicare Advantage plans may also have the option of covering meals that are delivered to an enrollee’s home, as well as transportation to and from doctor visits, and home safety features such as wheelchair ramps and grab bars installed in the bathroom. (Note here, though, that in order for a plan to cover these items, the meal delivery and / or home safety features must first be recommended to a patient by a medical professional).
In addition to the major benefit related changes for 2019, there are some other updated Medicare items to note. Several of these pertain to the potential out-of-pocket expenses that enrollees may have.
If you still have additional questions regarding Medicare’s 2019 improvements – which pertain to coverage and / or costs – there are several avenues available for finding more details. One option is to go directly to Medicare’s website at: www.Medicare.gov. Another is to discuss your potential coverage options, and your estimated out-of-pocket expenses, with an insurance professional who specializes in Medicare health plans.
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Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.