Medicare 2019 Changes

2019 Medicare & You - Changes in Medicare

You most likely already received your new Medicare & You handbook via mail. However, the electronic version offers some benefits. Instead of skimming through page after page looking for specific information you can get the PDF version here. Once you’ve opened the handbook you can press Ctrl+F on your keyboard and type in the search term you’re looking for. It should end up looking something like this:

Even with the ease of navigation my guess is that you probably:

  • Aren’t interested in comparing all 119 pages side by side with the 2018 Medicare & You handbook to see what’s different
  • Aren’t really interested in reading it all
  • Want to know what’s changed with Medicare
Good news. I’ll break down the highlights of what you need to know below:

Part D Donut Hole 2019

The Part D Donut Hole for 2019 has closed for brand name drugs and has tightened for generics. By 2020 the donut hole will also be closed on Generic drugs as well.

What does that mean?

While it’s good news because it will reduce your overall expenditure on drugs once you reach your initial coverage limit, it’s not all it’s been touted to be. Instead of paying 35% out of pocket for a brand name drug, with the donut hole closed you will only pay 25%. This could still mean a higher out of pocket cost than you are accustomed to. For example if your co-pay for a specific drug is $40 and the cost of that drug is $350 you will pay $87.50 out of pocket instead of your usual cost of $40. Over double what you usually pay. The generic drug cost sharing was reduced to 37% from 44$. So as I said before in my Part D Cost Sharing Guide the donut hole has merely shrank, not closed.

The Good: Overall expenses while in the donut hole will be reduced.

The Bad: For many seniors, they can still see an increase in how much they pay for their drugs once they surpass their initial coverage limit.

Medicare Advantage Open Enrollment Period

New for 2019 is the Medicare Advantage Open Enrollment Period which will run from January 1st – March 31st. It will replace the previous Medicare Advantage Disenrollment period that occurred from January 1st – February 14th.

What does that mean?

It means that not only do you have more time to make a decision in regards to your current Medicare Advantage plan, but you also have more options. Instead of being limited to dropping your current Medicare Advantage plan and returning to Original Medicare, you will now also have the option to switch to a different Medicare Advantage plan as well.

The Good: More time, more options, you’re not stuck with a provider that isn’t working well for you.

The Bad: None, really. May be overwhelming for those with buyer’s remorse after the new year who go back to square one with their research, but that’s all I can think of!

More Advantages for Medicare Advantage and Part D

There have been some recent changes to Medicare Advantage and Part D drug plans making them more attractive for plan year 2019.
What does that mean?

Lower Costs

In 2019 Medicare Advantage and Part D drug plans are seeing a reduction in average monthly premium

More Choices

In 2019 there will be an increase of approximately 600 more Medicare Advantage plans offered across the country.

More Coverage

In 2019 Medicare Advantage plans will be allowed to offer broader coverage including:

  • Transportation to and from Medical appointments
  • In-home support services (such as hand rails, and ramps)
  • Caregiver support services
  • Meal delivery
  • Home-based palliative care
  • Adult day care
  • Therapeutic massage
  • Nursing hotlines
  • Reduced cost sharing and additional benefits for enrollees with certain conditions, such as diabetes and congestive heart failure

Formulary Flexibility

 Part D plans will have the ability to substitute low cost generic drugs onto plan formularies at any point during the year which will help reduce cost sharing.

Medicare Advantage Trial Period

It’s not really called that, but it’s similar to the free look period offered to Medigap beneficiaries.

If you enroll in a Medicare Advantage plan during your Initial Coverage Election Period
you will have the option to switch to a different Medicare Advantage plan, or back to Original Medicare within the first three months of having Medicare. This may sound similar to the 12 month “Trial Right” period you have, but that only allows you to return to Original Medicare with a Guaranteed Issue Right with a Medigap policy.

The Good: There’s clearly a lot of reasons to like the changes to Medicare Advantage and Part D Prescription Drug plans. More flexibility, more benefits, lower cost.

The Bad: It appears that CMS and the Original Medicare program continue to push Medicare Advantage plans. And while it is good for some, others will be better off with a Medigap plan. It does leave questions to be asked, like: “Why is there such a push to encourage Medicare Enrollees to participate in Private Health plans?” Some people will find that the allure of the added benefits will cause them to select a plan that leaves them with big out of pocket expenses throughout the year that they would not normally incur with a Medigap plan. Again, coverage selection is largely based on individual needs, so I always recommend weighing out all of your options and eliciting the help of a Medicare Insurance professional. You can also read my guide on Choosing a Medicare Plan to give you ahead start on what to consider.

2019 Cost Sharing Increases

For 2019 your Medicare cost sharing received a very moderate increase:

  • Medicare Part A Premium – $437/mo.*

    $12 increase over the 2018 Medicare Part A premium of $422 

    *Most people qualify for premium free Medicare Part A

  • Medicare Part A deductible – $1,364

    $24 increase over the 2018 Medicare Part A deductible of $1340

  • Hospitalization Days 1-60 – $0 co-pay

    No change over the 2018 co-pay

  • Hospitalization Days 61-90 – $341 co-pay

    $6 increase over the 2018 co-pay of $335 co-pay

  • Hospitalization Days 91+ – $682 co-pay

    $12 increase over the 2018 co-pay of $670

  • Skilled Nursing Facility (SNF) Care Days 1-20 – $0 co-pay

    No change over the 2018 co-pay

  • Skilled Nursing Facility (SNF) Care Days 21-100 – $170.50 co-pay

    $3 increase over the 2018 co-pay of $167.50

  • Medicare Part B Premium – $135.50/mo.

    $1.50 increase over the 2018 Medicare Part B premium of $134

  • Medicare Part B deductible – $185

    $2 increase over the 2018 Medicare Part B deductible of $185

And there you have what I consider the most important and relative changes to Medicare and Medicare plans for 2019. While there are other technical changes and differences I only wanted to include what I thought would be helpful from a consumer’s perspective. If I missed anything that you’d like covered or found relevant let me know!

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Sean Senseman

Sean Senseman


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