Medicare improvements in 2019
According to AARP, there are “7 Ways Medicare Will Improve in 2019.”
Changes range from an early close of the prescription drug coverage donut hole to outpatient therapy caps gone to expanded Medicare Advantage plan benefits.
1) Medicare Part D (prescription drug coverage donut hole)
Thanks to the Affordable Care Act, the coverage gap is shrinking. The coverage gap does not close entirely but it shrinks to where beneficiaries will pay 25% out of their pocket in 2020 for generic drugs instead of 44% as in 2018 or 37% in 2019. Beneficiary out of pocket costs for brand name drugs drops to 25% in 2019 (one year earlier than generic drugs) instead of 35% in 2018.
When the total cost of your prescription drugs reaches your yearly out-of-pocket spending limit ($5,000 in 2018, $5,100 in 2019), you will get out of the coverage gap.
Closing the Coverage Gap – Medicare Prescription Drugs are Becoming More Affordable
2) Outpatient therapy caps changed to thresholds
From Centers for Medicare & Medicaid Services (CMS), Therapy Services Updated for 2019.
A “new law includes two provisions related to Medicare payment for outpatient therapy services including physical therapy (PT), speech-language pathology (SLP), and occupational therapy (OT) services.” It “repeals application of the Medicare outpatient therapy caps and its exceptions process while adding limitations to ensure appropriate therapy.” The law ” preserves the former therapy cap amounts as thresholds above which claims must include… a confirmation that services are medically necessary as justified by appropriate documentation in the medical record.” For Calendar Year 2018 (and each calendar year until 2028…), the Medical Review (MR) threshold is $3,000 for PT and SLP services and $3,000 for OT services.
3) Updates to the Medicare handbook and online Medicare plan finder.
4) Broadening access to telemedicine programs, where “patients confer with a doctor or nurse via telephone or the internet.”
The remaining three changes relate to Medicare Advantage plans.
5) Medicare Advantage plans coverage can include “lifestyle support” options.
“Medicare Advantage plans have the option to, when recommended by a medical provider, cover meals delivered to the home, transportation to the doctor’s office and even safety features in the home such as bathroom grab bars and wheelchair ramps. ”
6) Medicare Advantage plan coverage can include home health options.
“Medicare Advantage plans also will have the option to pay for assistance from home health aides, who can help beneficiaries with their daily activities including dressing, eating and personal care. ”
CMS put restrictions on the home health option in that it must address a diagnosis, specific illnesses and/or injuries. It has not been determined which Medicare Advantage plan providers will offer this option.
7) Under new regulations, people can “try a Medicare Advantage plan for up to three months and, if they aren’t satisfied, they can switch to another Medicare Advantage plan or choose to enroll in original Medicare.”
It is recommended a Medicare enrollee, whether it be in Original Medicare with a Medicare Supplement plan (Medigap) or Medicare Advantage, ensure that changes can be made after enrollment without negative consequences, e.g. higher prices or pre-existing condition limitations. In addition, confirm the time frames open for changes without negative consequences.
There may be additional changes to Medicare for 2019. We’ll wait and see as they are announced.