By Marcia Conard
Medicare, at 53 years of age, is 60 million members strong and it is about to get better! Let’s take a look at some changes coming in 2019.
To understand the changes, let’s first examine what Medicare is. Medicare is divided into four parts – A, B, C, & D.
• Part A – Partial Coverage for: Inpatient Hospital Stay, Skilled Nursing Care, Hospice, and Home Care
• Part B – Partial Coverage for: Doctor Visits, Surgery, Lab Tests, Medical Equipment, Preventive Exams
• Part C – Similar to Parts A & B with predictable out-of-pocket costs and more coverage.
• Part D – Helps with the cost of some prescription drugs not covered by Original Medicare
Parts A and B are what is known as Original Medicare. Part C is offered through private insurers and health plans. Part D is also offered through private insurers and health plans.
Medicare Advantage has eliminated the disenrollment period that existed from January 1st through February 14th each year and replaced it with a new Medicare Advantage open enrollment period that runs from January 1st through March 31st annually. This basically allows a 3-month time period in which to try out a Medicare Advantage plan. If you aren’t satisfied you can:
• Disenroll from your current Advantage Plan
• Enroll in a different Advantage Plan
• Go back to Original Medicare
• Add or change a Part D Plan.
Medicare sends a handbook to beneficiaries each fall. Medicare has revised the handbook, including information to assist enrollees to compare out-of-pocket costs and coverage options between Medicare Advantage and Original Medicare.
Patients will have a broadened use of telephone and online visits with doctors and nurses. 2019 will see these services extended to patients with an end-stage renal disease or during treatment for a stroke.
As of January 2019, Medicare Advantage plans can offer the option of a variety of services if the patient’s medical provider recommends benefits such as:
• Meals delivered to the home
• Transportation to the doctor’s office
• Home-safety improvements such as bathroom grab bars and wheelchair ramps
Congress permanently repealed the therapy cap allowing beneficiaries of Original Medicare to no longer have to cover the full cost of outpatient physical, speech or occupational therapy. Previously, there was only limited coverage for those services.
Starting in 2019, Medicare Advantage plans can offer the option of in-home help. Traditionally Medicare required that the services had to be primarily health-related. Under the new definition, the plans may offer an option to pay for assisted care from home health aides who can help beneficiaries with personal care, dressing, and eating.
Under Medicare Part D, there has existed a coverage gap called the “donut hole.” Those beneficiaries who have high prescription costs reach the pre-donut hole ceiling far more quickly and then experience much higher out-of-pocket expenditures before they meet the limit and enter the catastrophic coverage phase and begin to pay substantially lower amounts under Part D. Congress passed a spending bill in March, 2018 which will cause the donut hole to close for brand-name drugs in 2019 followed in 2020 for the generic drugs.
This is not an all-inclusive list of changes or of what the 2019 plans may offer. It is important that you meet with your health care insurance agent to find the plan that best fits your needs for 2019.
The Annual Election Period for Medicare runs from October 15, 2018, through December 7, 2018.
In the Greater Blue Water Area, call Grant Smith Insurance Agency, LLC today to set up your appointment. The appointment is free, the assistance is priceless! (810) 984-1373
Marcia Conard is a life-long resident of the Blue Water Area. Marcia has an Associate of Science Degree from St. Clair County Community College. Marcia was licensed by the Federal Government as a Customhouse Broker and worked in Management and as a Director for over 30 years in the Customs Brokerage business. Marcia has two grown sons also living and raising families in the Blue Water Area. Marcia joined the Grant Smith Health Insurance Agency as the Operations Manager in May, 2017.