Changes to Medicare in 2019


A lot of insurance companies and brokers will send out mailers asking if you want the latest changes to Medicare. Honestly, Medicare doesn’t change that much. However, for the year 2019, there are some pretty interesting changes in store. One new element coming into play is the Medicare Advantage Open Enrollment. This is going to take place January 1 - March 31 starting in 2019. This is strictly for people who are enrolled in a Medicare Advantage plan on January 1. These folks will be allowed to change that Medicare Advantage plan one time between January 1 -March 31. You could even drop that Medicare Advantage plan and go into Original Medicare with a Prescription Drug Plan if you wanted.

If your health allows, you could apply for a Medicare Supplement at that moment. Medicare Supplement plans do not require an open enrollment period to apply. However you cannot enter a Medicare Supplement while on a Medicare Advantage Plan.

You might be wondering what a Medicare Advantage Plan is. It is an insurance plan that carries the categories of either HMO, PPO, PFFS, or MSA. Generally you have co-pays and co-insurance when you have medical services. The monthly premiums are generally pretty low as well.

The other change relates to the Coverage Gap, or Donut Hole, in conjunction with a Prescription Drug Plan. If you have experienced reaching the Coverage Gap, then you know what I'm talking about. This is essentially a gap in your prescription coverage that makes your cost sharing for your prescription go up when you reach a certain dollar amount.

The Coverage Gap has been something that has been shrinking since 2015 and was scheduled to pretty much close in 2020.

The Bipartisan Budget Act of 2018 moved up the date for closing the coverage gap for brand name medications. Anyone who is taking brand name medications will continue to pay approximately 25% of the medication cost even when in the coverage gap/donut hole.

That is great news for people who are taking some pretty expensive medications.

Generic medications will join the brand name medications in 2020 and have a cost share of 25% as well. But for 2019, generic medications will be at 37% cost sharing during the Coverage Gap.

If that is a little confusing, please contact me and I will be happy to talk you through it. It really does sound like a foreign language. Ha ha.

I know there will be more changes coming at the turn of the new year in the way of out-of-pocket costs when on Original Medicare as well as possibly the Part B monthly premium. I will keep you posted as soon as I hear that information. I usually see it at the end of November or beginning of December.


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