Here’s some good news to start the year! In 2019, we’ll see improvements in coverage across the major Medicare plans.
About two-thirds of people on Medicare use “original Medicare.” Patients with original Medicare can go to any health care provider that accepts Medicare. Original Medicare pays for 80% of costs after a yearly deductible. The remaining 20% is paid out of pocket. In addition, your loved one may have a supplemental insurance. Sometimes this is called “Medi-Gap.” Medi-Gap policies pay the deductible and that 20%.
There is also a “Medicare Advantage” plan. If your family member has this coverage, he or she must go to providers who are part of the plan’s network. Medicare Advantage programs usually cost less than a combined original Medicare and Medi-Gap policy.
Starting in 2019
“Donut hole” is closing early
Medicare Part D has been paying roughly 75% of medication costs up to a set amount per year. Patients paid the balance of 25%. If costs were higher, the patient had to pay a greater percentage out of pocket (35-44%). If your relative’s drug costs reached a second threshold, additional medicines were then covered 95% by Medicare, 5% by the patient. In 2019, that “donut hole” gap in coverage is “closing,” meaning it is getting smaller. And a year earlier than planned. This year Medicare will extend coverage of brand name drugs at 75% up to the second threshold. Then 95% coverage will kick in. Generics will have a 63% coverage rate after the first threshold. The following year, generics will be covered at the 75% rate as well.
Nonmedical support services
Some Medicare Advantage Plans have been given permission to expand coverage beyond traditional medical care. With a doctor’s orders, for instance, they have the option to offer policies that provide for things like the installation of grab bars or a wheelchair ramp. Check your loved one’s plan to see if it includes this type of coverage.
Want to switch policies?
Wish your loved one had a different plan? As of 2019, those with an existing Medicare Advantage plan may switch to a different plan within the first three months.
Do you find Medicare confusing?
You aren’t alone! As the Metro DC experts in family caregiving, we at Debra Levy Eldercare Associates can help you decide if there’s a plan that would be better. Give us a call at 301-593-5285. Let’s start the conversation.