Medicare Advantage: Changes Coming in 2019

How to find your best coverage

Medicare Advantage (also referred to as Part C) is a coverage plan that is a reasonable alternative to Original Medicare (Part A and Part B) for seniors who want to extend their coverage options. There are certainly pros and cons to choosing one type of Medicare over another; however, a better understanding of each plan can help you to make a more informed decision.

More than 20 million people opted for Medicare Advantage over Original Medicare in 2018. This number is expected to increase to more than 23 million in 2019 due to legislative changes made in the Bipartisan Budget Act of 2018. Are these changes enough to entice you to choose a Medicare Advantage plan?

Cost

Whether or not you choose a Medicare Advantage plan or Original Medicare, you are responsible for paying Part A and Part B premiums. If you or your spouse worked 40 quarters (10 years) in Medicare-taxed employment, you get Part A premiums for free.

However, everyone pays Part B premiums—the amount depends on your income. The government will look at your tax return from two years prior and put you into one of six income brackets. In 2019, you will pay $135.50 per month ($1,810 per year) in the lowest income bracket up to $460.50 per month ($5,711 per year) in the highest income bracket.

If you want to sign up for a Medicare Advantage plan, you may need to pay a premium for that plan as well.

In certain cases, there may be no premium at all. This depends on the specific plan, the size of the annual deductible, and how extensive the coverage.

The Centers for Medicare and Medicaid Services (CMS) announced that monthly premiums for Medicare Advantage plans will go down by 6 percent in 2019. In reality, this is a minor change that is unlikely to significantly affect beneficiaries. A decrease in the average premium from $29.18 to $28 per month will only save you $21.72 per year.

Coverage

Original Medicare does not cover everything, which is the most common reason that people turn to Medicare Advantage plans.

The federal government allows Medicare Advantage plans to cover certain supplemental benefits. These benefits have generally been restricted to items or services that relate directly to primary health care. For example, these plans may add corrective lenses (contacts and eyeglasses), hearing aids, and preventive dental care to their benefits packages.

Effective January 2019, CMS will now “allow MA plans more flexibility in offering supplemental benefits that can enhance beneficiaries’ quality of life and improve health outcomes.”

The goal is to decrease the complications from chronic conditions, to decrease the risk of injury, and to reduce the need for emergency services and otherwise preventable health care.

By adding benefits that keep people healthier longer, insurers can expect to save money as well.

As seniors grow older, many may need assistance if they are going to continue to live at home. Some may not be able to drive, and others may not be able to perform activities of daily living like dressing and feeding themselves. Services that could be covered by Medicare Advantage plans in 2019 include the following:

  • Adult day care
  • Home health aides (to assist with non-medical activities of daily living such as chores, dressing, eating, and toileting
  • Home safety equipment (such as grab bars for bathtubs, shower support bars, wheelchair ramps)
  • Increased telehealth access (includes telepsychiatry)
  • Meals delivered to the home
  • Ride-share coverage to and from medical appointments
  • Respite care for caregivers

Whether or not a Medicare Advantage plan covers these services and to what extent will be determined by the individual plan. It's important to remember that Original Medicare is run by the federal government but Medicare Advantage plans are run by private insurance companies.

Signing Up

Traditionally, signing up for (or canceling) your Medicare Advantage plan is limited to three enrollment periods and one disenrollment period.

Initial Enrollment Period (IEP)

You can sign up for Medicare when you turn 65 years old. The enrollment period starts three months before and ends three months after your birth month. If you miss your IEP, you will face late penalties when you finally do sign up.

Special Enrollment Period (SEP)

People who have employer-sponsored health plans can wait to sign up for Medicare until they leave their jobs or lose their health insurance, whichever comes first. They have eight months to enroll in Medicare.

To qualify for SEP, your employer has to hire the equivalent of at least 20 full-time employees. Otherwise, you will face late penalties if you missed your IEP.

Open Enrollment Period (OEP)

People can change their Medicare plans every year during the OEP, which happens from October 15 to December 7 every year. You can switch back and forth from Medicare Advantage to Original Medicare or change to a new Medicare Advantage plan.

Medicare Advantage Disenrollment Period (MADP)

You could cancel your Medicare Advantage plan and go back to Original Medicare during the MADP from January 1 to February 14 every year.

Starting in 2019, there will be a new enrollment window specifically for people who have Medicare Advantage plans.

The MADP will disappear. In its place, there will be a Medicare Advantage Open Enrollment Period that runs from January 1 to March 31. During this time, you can change to a different Medicare Advantage plan, sign up for (or cancel) a Part D drug plan, or change to Original Medicare.

Think of this as a "test drive" of a Medicare Advantage plan before you actually commit to the plan for the year.

A Word from Verywell

Recent legislative changes have made Medicare Advantage plans more enticing for consumers. Before you make any decisions about your health care, however, it's good practice to first find out the specifics of what a 2019 Medicare Advantage plan has to offer. From there, you can make a more informed decision on your coverage.

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