The new year is approaching, and it seems that the people in charge of Medicare have already made a new year’s resolution to make Medicare coverage better in 2019. Changes include an early close of the so-called donut hole and expanded benefits for Medicare Advantage plans. Medicare coverage was introduced fifty-three years ago and now has 60 million members. The program gets higher approval ratings than almost any other kind of health insurance, so it must be getting some things right. Now, it’s about to get even better. The following are six improvements that will come into effect in 2019. Some of these changes apply to all Medicare beneficiaries; some will apply only to those enrolled in a Medicare Advantage plan.
The Donut Hole will Close in 2019 for Branded Drugs
An expensive part of the Medicare Part D prescription drug program requires enrollees with high prescription drug costs to pay more after reaching a certain spending threshold in one year. This creates a coverage gap with the catchy name of the donut hole. After a beneficiary’s out-of-pocket expenditures reach a second level, they then pay substantially less under catastrophic coverage. The Affordable Care Act (ACA) mandated the closing of the donut hole in 2020, but for brand-name drugs it will now snap shut in 2019. The gap for generic drugs will still stay open until 2020.
The Therapy Cap will be Gone
Historically, payments for physical, speech, and occupational therapy have been capped, although Congress every now and again has passed bills to provide exceptions for medically necessary treatments. Medicare beneficiaries were capped out when a certain level was reached. Congress has now permanently repealed the cap effective in 2019. This means that Medicare beneficiaries will now be able to afford the extended therapy they may need.
Better Information is Available
Medicare has updated the handbook it sends out every fall. The guide will now include handy checklists and flowcharts making it easier to decide on the type of coverage to choose. The online Medicare Plan Finder tool will also be easier to use, and there is an improved “coverage wizard” to help enrollees compare coverage options and out-of-pocket expenditures between original Medicare coverage and Medicare Advantage.
Medicare has been steadily broadening the availability of telehealth programs that enable patients to talk to a medical professional via phone or the internet. In 2019, it will begin coverage of telehealth services for individuals being treated for a stroke or with end-stage kidney disease.
More Choices for Medicare Advantage Plans
Increased Lifestyle Support – Medicare Advantage plans can choose to cover the following. (To be covered, it will be necessary for a medical provider to recommend these benefits.)
- Home delivery of meals.
- Transportation to a doctor’s office.
- Home safety features such as grab bars for bathtubs and wheelchair ramps.
- Assistance from home health aides who can assist beneficiaries with daily activities such as dressing, eating, and personal care.
Ability to Test Drive a Plan
New regulations will allow people to try an Advantage plan for up to three months. If they aren’t satisfied, they will be able to switch to another Advantage plan or choose original Medicare.
Choose Your Plan Carefully
It’s important to evaluate your health needs and to choose either basic Medicare coverage or the right Medicare Advantage plan. Take advantage of the improved Medicare handbook – and here’s a link that may help you if you need more information. If you need in-home health care for a loved one, choose an Advantage plan that will fulfill your requirements. And, if you live in or near Columbia, South Carolina and are looking for the best in-home care, Caring Healthcare is here for you. Give us a call for more information.