Change is Coming in 2019

Medicare, now 53 years old, is one of the success stories of American health care.  The system is popular and has high rates of satisfaction from its 60 million members than most any other form of health insurance.  And, it is about to get better.   Below are seven improvements to Medicare announced for next year – some apply to the original program and other benefits those who buy Medicare Advantage plans.

  1. The Donut Hole Disappears – The Medicare Part D benefit has an unpopular part where enrollees have to pay more for their drugs after they reach a certain level of spending.  After their out of pocket spending reaches another threshold enrollees enter a catastrophic coverage and pay substantially less.   This area, commonly called the “donut hole” was scheduled to close in 2020 under the Affordable Care Act.  However, the new omnibus spending bill passed in March will close the donut hole for brand-name drugs in 2019, and generic drugs in 2020.
  2. Therapy Cap Gone – Congress has permanently repealed the limited cap coverage for outpatient physical, speech and occupational therapy.  This will allow beneficiaries of the original Medicare not to pay the full cost of these services.
  3. Better Information – Medicare is updating the handbook it sends to beneficiaries every fall.   It will include checklists and flowcharts to make it easier to decide on coverage.  The online Medicare Plan Finders is also being improved to allow you to compare out of pocket cost and coverage options between traditional Medicare and Medicare Advantage.
  4. More Telemedicine – Medicare is broadening the availability of telehealth programs that let patients confer with doctors or nurses via telephone or internet.  2019, will cover these services for those with end-stage renal disease or during treatment for a stroke.
  5. Potential Lifestyle Support – In 2019 insurers selling Advantage plans have the option to cover meals delivered to the home, transportation to the doctor’s office and even safety feature in the home such as bathroom grab bars and wheelchair ramps.  The options will have to be recommended by a medical professional.
  6. In-Home Help – Medicare Advantage plans have been given the option to pay for assistance from home health aides, which can help people with their daily activities including dressing, eating and personal care.
  7. Plan Test Drives – New regulations will let people try an Advantage plan for us to three months – and then switch to another Medicare plan, including original Medicare if you want to. Congress mandated this in the 21st Century Cures Act, designed to accelerate innovation in health care.

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