New year, new Medicare plan? Whether you enrolled in a new plan for this year or not, there are always some changes to be mindful of. As 2019 gets under way, now is a good time to review this year’s important Medicare changes plus the key numbers for 2019 plan costs and deductibles.
I’m going to highlight five specific changes, two involving Medicare Advantage plans, two for Medicare Part D drug plans, and one for private Medigap supplement insurance plans. Then, I’ll list the key numbers for 2019 plan costs, deductibles and the like.
Medicare Advantage (MA) Plans: New Open Enrollment Period
If you have an MA plan, you should know that there is a new open enrollment period that began Jan. 1 and extends through March 31. Whether you signed up for a new MA plan during last fall’s annual enrollment period for Medicare or kept the same MA plan, you can choose to change plans during the first quarter of 2019 in one of the following ways:
- Switch from your current MA plan to another one, either with the same insurance company or another insurance company that offers plans where you live. You can see a list of MA plans where you live by going to Medicare’s online Plan Finder, entering your ZIP code, and following the onscreen instructions.
- Disenroll from your MA plan and get your coverage from Original Medicare, which covers hospital and nursing home care (Part A) and expenses for doctors, outpatient services, and durable medical equipment (Part B).
- Enroll in a standalone Part D drug plan, if you return to Original Medicare.
- Add a Medigap supplement plan, which helps pay for covered expenses that Original Medicare does not fully cover. In most states, private Medigap insurers may be able to charge you more for any pre-existing health conditions or even decline to sell you a Medigap plan. For this reason, it’s a good idea to research your Medigap options before leaving MA altogether.
MA Plans: Supplemental Benefits
The second notable change in MA plans is that certain plans now offer new types of coverage for what I call non-medical expenses – or supplemental benefits – things like transportation to doctors’ appointments, fresh meals delivered to the homes of people after they have been discharged from hospitals, and home-safety devices such as bathroom grab bars. Only a small percentage of MA plans are offering these new features this year, and in limited markets; they are expected to be more widely available in 2020.
Part D Drug Plans: Discounting the Donut Hole
The coverage gap, or donut hole, in Part D drug plans is closing this year, at least for branded drugs! As a result, upon reaching the donut hole (once total expenses for you and your drug insurer have reached $3,820), you will pay no more than 25 percent of the cost of branded drugs. At this time, you will need to pay 37 percent of the cost of generic drugs. This gap for generics will also be closed in 2020, and the coinsurance for all drugs will then be 25 percent.
Once your drug plan out-of-pocket costs, not including plan premiums, have reached $5,100 in 2019, you will enter the so-called catastrophic phase of plan coverage and will pay significantly lower copays or coinsurance for most prescriptions and no more than 5 percent of the cost of expensive drugs.
Part D Plans: “Extra Help” Enrollment Windows
The second notable change within Part D plans affects people with lower incomes who qualify for the Extra Help program in paying for their prescribed medications. If you qualify for this program, you can get special enrollment periods to change drug plans in each of the year’s first three quarters. (You can change plans in the fourth quarter as part of Medicare’s annual enrollment period, which runs from Oct. 15 through Dec. 7.)
Prior guidelines permitted Extra Help users to change plans anytime they wished, and some Medicare advocates have raised concerns about the more restrictive rules.
Medigap Supplement Plans: Changes for people enrolling in Medicare starting next year
If you will be shopping for Medigap coverage effective Jan. 1, 2020, or later, you may not be able to get the popular Letter C and F plans. These plans provide the most comprehensive coverage of costs not paid by Original Medicare, including paying the annual Medicare Part B deductible.
Several years ago, Congress voted to curb such “first dollar” Medigap coverage starting in 2020 by closing off the plans to people who were not already on Medicare by 2020. That means people who turn 65 on or after Jan. 1, 2020, and weren’t already enrolled in Medicare before that date, won’t be able to buy the most comprehensive Medigap plans.
BUT, anyone who turned 65 before 2020 OR was on Medicare due to disability before 2020 can still buy Letter C and F plans in the future. That also means people who already have Letter Plans C and F can keep them.
Key Numbers for 2019
Here are some important Medicare numbers for 2019, courtesy of the Medicare Rights Center.
- Deductible: $1,364 for each benefit period
- Hospital coinsurance: $0 for first 60 days; $341 per day after 60 days; $682 per day after 90 days
- Skilled nursing: $0 for first 20 days; $170.50 per day after 20 days
- Standard monthly premium: $135.50
- Annual deductible: $185
- Monthly premium: Varies by plan; basic monthly premium for minimum Part D plan: $33.19
- National monthly base beneficiary premium (NBBP – used to calculate how much you own in Part D penalties if you sign up late for benefits): $33.19
- Maximum annual deductible: $415
Journalist Phil Moeller is an expert on retirement and aging. He writes the “Ask Phil” column for the PBS NewsHour and is the author of “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs” as well as the co-author of the updated edition of The New York Times bestseller “How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” You can follow him on Twitter (@PhilMoeller) or reach him via e-mail: AskPhilByUHC@gmail.com.
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. For Medicare Advantage and Prescription Drug Plans: A Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare.