Healthy Living

Medicare 101 – New for 2019

While Medicare makes changes from year to year in its premiums, deductibles, and copays, there were also a number of legislative changes for 2019. Most of these changes are for the better, so let’s take a look at each one and how it might benefit you.

Improvements to Medicare Advantage Allowed Benefits

Medicare Advantage plans are an alternative to Original Medicare. Members who enroll in them will get their benefits from the plan’s network and pay copays according to the plan. Advantage plans are allowed to include extras like Part D built right into the plan as well as routine dental and vision services.

Beginning in 2019, plans will also be able to incorporate new supplemental home benefits. Designed for people who are chronically ill, these new benefits might help to prevent expensive hospitalizations. Plans can now build in benefits like custodial in-home support, adult day care, in-home meal delivery and even safety modifications like bathroom grab bars. Observers have noticed that these new benefits stray into the area of long-term care and are therefore likely to be very popular with seniors who know that Original Medicare doesn’t cover these services.

A New Election Period

Another new change affecting people with Medicare Advantage plans is the Part C Open Enrollment Period which will occur each year from January 1st through March 31st. During this 3-month span, beneficiaries who are enrolled in Advantage plans can make a one-time change to a different Medicare Advantage plan. They can also choose to just disenroll from their plan and return to Traditional Medicare while picking up a standalone Part D drug plan at the same time.

This is a welcome relief to many beneficiaries who are tempted to try an Advantage plan during the fall Medicare Annual Election Period but don’t like the idea of being locked into the plan for a whole calendar year. Now they’ve got an easy out if things aren’t what they hoped.

Better Physical Therapy Benefits

While Medicare Part B has always covered physical therapy, there have been limits in the past which negatively affected people with certain health conditions. In the past, Medicare has wanted physical therapy only if would result in marked improvement and was medically necessary. While therapy must still be medically necessary, CMS has removed the requirement for improvement because it recognizes that people with chronic conditions like Multiple Sclerosis or Parkinson’s Disease can truly benefit from ongoing therapy that helps them maintain balance, flexibility, and mobility.

Medicare implemented a higher and softer cap on therapy benefits which allows the therapist to provide additional therapy if necessary, without having to file more paperwork.

New Technology

Another neat change is that Medicare has created its first app! The new What’s Covered App will be much appreciated by beneficiaries who constantly wonder if their medical procedures are covered. They’ll now be able to search the app before they undergo a healthcare service to check and make sure that Medicare routinely covers that service. It’s expected that this will help to prevent misunderstandings where the beneficiary allows a procedure only to get a denial in the mail from Medicare later on.

Reduced Spending in the Donut Hole

Yet another change for the better will affect Medicare Part D plans. All plans have 4 stages and one of these is the coverage gap or Donut Hole. The Affordable Care Act legislation has slowly been reducing the cost that Medicare beneficiaries pay toward their medications in the donut hole.

In 2019, they will now pay only 25% of the cost of brand-name drugs in the gap and slightly more for generics. This is the lowest percentage that beneficiaries have ever paid, and it will help individuals in the gap to better afford their medications.

Staying on top of Medicare’s changes each year is important so that you can always know ahead of time about anything that may affect you personally. If something is changing on your plan that you aren’t crazy about, you have the Annual Election Period in the fall to make changes to your Medicare Advantage plan or Part D drug plan. Your new plan will always begin the following January.

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