By Camille Barron
The other day, my husband Jim and I were having dinner with friends when the topic of how we met came up. We shared the story of how we were introduced at a local restaurant while attending a social function. Things moved steadily from there and one year later — to the day — we were married in that exact same location!
Not only that, coincidentally, our 13th wedding anniversary — October 15th — was coming the very next day, something our friends were quick to point out. Jim and I, on the other hand, had both completely forgotten!
Jim doesn’t have a good excuse for forgetting, but I do: Ever since I’ve been in the Insurance and Medicare business, what I most associate with October 15th is the start of Open Enrollment for Medicare Advantage and Medicare Prescription Drug Coverage.
Open Enrollment runs from October 15 through December 7, 2018, something you may have noticed with all the TV commercials and piles of mail that have been arriving. As always, there are changes this year compared to last. Let’s look at some of the most significant and explore why they matter to you.
1) Medicare Part B — Standard Premium
Medicare Part B covers your doctors’ fees and outpatient medical expenses (things like labs, imaging, physical therapy, etc.). The standard monthly premium will be $135.50 for 2019, an increase of $1.50 from $134.00 in 2018.
Note that approximately 3.5% of Medicare beneficiaries (an estimated 2 million individuals) will pay less than the full Part B standard monthly premium amount in 2019 due to the statutory “hold harmless provision,” which limits certain beneficiaries’ increase in their Part B premium to be no greater than the increase in their Social Security benefits.
2) Medicare Part D — Prescription Drug Insurance
One component of Medicare that began in 2006 is Part D prescription drug coverage. To obtain this, you select a prescription drug plan (PDP) from the many (4-26) available in your specific county/zip code. The best choice for you will depend on the specific drugs you take and the prescribed dosages. This year, the number of Medicare Part D plans has increased significantly — from 782 in 2018 to 901 in 2019.
That means more choice, of course, but it also means that simply doing what you did last year may not be your best option. For one thing, your prescriptions may have changed from year to year, meaning that last year’s plan is no longer the most cost-effective.
Even without any modification to your medications, as plans change and new ones emerge, it’s important to do an annual review of Part D to make sure you’re getting the most appropriate and cost-effective coverage.
One last thing regarding Part D: The “Donut Hole” — a component of the original legislation that included participants paying a higher share once the total cost of their prescription drugs exceeded a stated threshold — is continuing to close as a result of the Affordable Care Act (ACA). Over the next two years, through 2020, you’ll see a decrease in the amount you pay for both brand name and generic drugs whenever you are within the Donut Hole. Good news!
3) Income Adjustment Amounts (IRMAAs) for Medicare Parts B and D
Medicare Part B covers your doctors’ fees and outpatient medical expenses. Part D is coverage for prescription drugs.
In both cases, higher income beneficiaries are also required to pay a surcharge, something known as the Income Related Monthly Adjustment Amount (IRMAA) and it’s based on their Modified Adjusted Gross Income (MAGI) from two years earlier.
The most significant change for 2019 is the introduction of a new tier for Medicare beneficiaries with the highest incomes. Please see the table below for the income thresholds and for the IRMAA amounts for Medicare Part B and Part D premiums.
NEW MEDICARE INCOME RELATED MONTHLY ADJUSTMENT AMOUNTS FOR 2019
(BEFORE 2019 MEDICARE INFLATION ADJUSTMENTS)
4) Medicare Advantage Plan Changes
Medicare Advantage Plans (also known as Medicare Part C) are plans offered by private insurance companies that contract with Medicare and can be chosen in lieu of traditional Medicare Parts A, B and D. They come with a broad range of options and types, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Private Fee-for-Service (FFS) Plans. It’s worth noting some changes for 2019 in these plans:
First, beginning next year, Medicare Advantage Plans will have the option to cover meals delivered to the home, transportation to doctors’ offices and in-home safety improvements, such as wheelchair ramps and bathroom grab bars. (These benefits must be recommended by the individual’s medical provider and may not be available in some plans.)
Second, Medicare Advantage plans may elect to pay for in-home assistance from home health aides who help individuals with daily activities such as dressing, eating and personal care. Previously, these plans only covered services that were primarily health-related.
Third, Medicare Advantage Plans will have the option of applying “step therapy” for certain drugs. Step therapy is a type of prior authorization that requires a patient needing medication to use condition-based “preferred” medications before using more expensive drugs, and progress to other treatments only if necessary. There’s debate as to the benefits of this approach. Some argue it will lower prescription drug costs up to 20%. Others are concerned that it may cause delays in dispensing prescriptions.
As always, sorting through the options and finding the coverage that’s best for you and/or your loved one can be time-consuming and tedious. So, make plans to spend time reviewing the options (choices made during Open Enrollment will remain in effect through all of 2019) and don’t hesitate to get in touch if we can help!