As with most other years, Medicare enrollees will see some changes made to this health care program for the coming year, 2019. But, while it is estimated that the updates made with regard to Medicare Advantage plans (Medicare Part C) and Medicare prescription drug coverage (Medicare Part D) could save this program nearly $300 million annually going forward, how much will individual enrollees be able to save?
The answer here is still a bit unclear. However, based on some of the updates, Medicare beneficiaries could benefit in other ways, too.
There is actually a lengthy list of proposed changes on the 2019 horizon for Medicare Advantage and Medicare Part D – beginning with the Centers for Medicare and Medicaid Services (CMS) lifting various restrictions on the types of Medicare Part C plans that insurance carriers are allowed to offer.
In addition, the CMS will also be streamlining the review process for advertising and marketing materials that are presented to potential purchasers – and, Medicare Advantage insurance carriers will also be able to send various documents to enrollees electronically as versus using only “snail mail.”
Likewise, there are some updates coming with Medicare Part D plans, too. One key change is that, based on CMS rules, Medicare Part D plans will be able to restrict access to opioids – along with certain other prescription medications – for Medicare enrollees who may be at risk for addiction. (These medications, however, will not be restricted for those who have been diagnosed with certain types of cancer, as well as those who are receiving hospice care and who may benefit from this type of pain management medication).
There are also some Part D plan-related revisions with regard to Medicare beneficiaries who reside in nursing home facilities. Here, the drug plan may be allowed to reduce the quantity of various medications that are supplied to patients at one time.
In this case, for instance, rather than providing a Part D plan holder with a 90-day supply of their prescription medication all at once, he or she will instead receive a supply that will last for 30 days.
Also, provided that the Medicare prescription drug plan follows certain rules, the Centers for Medicare and Medicaid Services will be allowing increased flexibility for formulary changes in Part D plans.
With that in mind, if you are a Medicare Part D prescription drug plan enrollee, be sure that you check your plan’s formulary in order to determine whether or not any changes to your particular prescriptions have been made. If so, it may be time for you to switch to a different plan that offers you better coverage options.
Although the bulk of the changes to Medicare plans for 2019 may benefit the insurers that provide the coverage, there are some benefits to the consumers who are enrolled in these forms of Medicare coverage.
For instance, one way that consumers may benefit – at least as it pertains to securing Medicare Advantage coverage – is through the new open enrollment period for these types of plans. This is called the Open Enrollment Period, which is revitalized for the first time in several years in early 2019. I wrote a great article about this earlier this year, and you can access it by clicking here.
During this period of time, Medicare Advantage enrollees are allowed to do a number of things that pertain to their Medicare coverage, including making a change to a different Medicare Advantage plan, dropping Medicare Advantage and returning to Medicare Part A and B (also known as Original Medicare), dropping a stand-alone Medicare Part D prescription drug plan, and / or enrolling in a new Medicare Part D plan (provided that they are also enrolled in Original Medicare for the following year).
For individuals who are currently enrolled in a Medicare Advantage plan – and who also wish to remain in their same plan for next year – the new Medicare rules will allow the plans to renew coverage for enrollees automatically. This can make remaining in the same plan easy and more convenient.
Medicare’s coverage can oftentimes seem difficult to understand. In fact, there are many areas where the information can actually be overwhelming. But if you are a Medicare enrollee – regardless of whether you are covered by Original Medicare (Part A and Part B, and possibly a stand-alone Part D plan), or by a Medicare Advantage plan, you need to know what is and is not covered.
This type of knowledge can be extremely beneficial in determining whether or not your current plan will still provide you with adequate coverage, and / or when you are comparing other plans with the intention of making a change.
If you’re doing any research for Medicare plans online, you can find a great deal of information on Medicare Part A and B coverage directly on Medicare’s own website. However, if you have – or if you are considering – coverage through a Medicare Advantage plan, it is oftentimes necessary to contact the plan provider directly. Alternatively, you can discuss your health care needs and your coverage options by talking with a Medicare insurance plan expert in your area.
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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.