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2019 Medicare Updates

By: Financial Hotline
Winter 2019 (Vol. 36, No. 4)

New Medicare Advantage open enrollment period

When you enroll in Medicare, you can choose between the traditional program (which includes Part A, Part B, and a Part D drug plan) or Medicare Advantage. The Advantage option bundles hospital, health and prescriptions into a single plan. Advantage plans also offer dental, hearing, and vision plans – which are not covered under regular Medicare.

Starting in 2019, Medicare Advantage will get its own open enrollment period that will begin on Jan. 1 and continue through March 31. If you’re enrolled in an Advantage plan, you’ll have a chance to switch to a different one or drop your Advantage plan and sign up for original Medicare instead. Don’t confuse this with traditional Medicare’s open enrollment, which runs from Oct. 15 through Dec. 7 each year.

Closing the donut hole

In the past, Medicare beneficiaries paid their deductible if applicable, and their copays(coinsurance) until the costs reach $3,750 for their prescriptions medications. Once a beneficiary drug cost exceeded $3,750, beneficiaries became responsible for paying up to $5,000 for their prescription drugs. After $5,000 was paid out of pocket, Medicare beneficiaries paid 5% of the cost of their prescription drugs for the remainder of the year. (Note: $3,750 is the full cost of the drug – not what you paid towards it.) 2019 changes to the Medicare Part D Donut Hole include:

  • Brand name drugs will be covered at 75%, reducing your shared cost to 25%.

  • Generic drugs will be covered at 63%, reducing your shared costs to 37%.

  • Standard initial deductibles are projected to increase from $405 to $415 a month.

  • Your initial coverage limit is projected to increase from $3,750 to $3,820.

  • The donut hole true out of pocket cost (TrOOP) is projected to increase to $5,100 from $5,000. However, you are paying less money out of pocket to reach the $5,100.

  • After you reach the $5,100, you become eligible for catastrophic coverage. At that point both your generic and brand drug purchases will be covered at 95%.

Increased coverage for outpatient services

In 2019, Congress permanently repealed the cap that has historically limited coverage of outpatient physical, speech or occupational therapy for traditional Medicare recipients.

Upgraded communication

Updates to the Medicare handbook will include checklists and flowcharts to make it easier to decide on coverage. The online Medicare Plan Finder tool should also be more user friendly featuring a “coverage wizard” to help with comparing out-of-pocket costs and coverage options between original Medicare and Medicare Advantage.


Medicare is steadily broadening the availability of telehealth programs that let patients confer with a doctor or nurse via telephone or the internet. In 2019, it will begin covering telehealth services for people with end-stage renal disease or during treatment for a stroke.

More home health coverage

Beginning in 2019, Medicare Advantage plans have the option to cover meals delivered to the home, transportation to the doctor’s office and even safety features in the home such as bathroom grab bars and wheelchair ramps. To be covered, a medical provider will have to recommend benefits such as home-safety improvements and prepared meals.

Medicare Advantage plans also will have the option to pay for assistance from home health aides, who can help beneficiaries with everyday activities such as dressing and bathing. These benefits represent a broader definition of the traditional requirement that Medicare services must be primarily health related.

Test Drive a new plan

New regulations by Congress in the 21st Century Cures Act, will allow you to try out an Advantage plan for up to three months and, if they aren’t satisfied, switch to another Medicare Advantage plan or choose to enroll in original Medicare.