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2019 Changes To Medicare That You Need To Know

image-from-rawpixel-id-65844-originalMedicare provides crucial health benefits for millions of Seniors and underage eligible beneficiaries, and whether you are new to the program, or are currently enrolled, the upcoming year brings with it a number of changes you should to be aware of.

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1. Medicare Part B Premiums Are Increasing:

Part B, which covers doctor and other health care providers' services and outpatient care, charges a premium for coverage. In 2018 the standard monthly premium is $134, but that amount will be rising by $1.50, making the standard monthly premium amount for 2019 $135.50. However, if you are a higher earner, you could end up paying significantly more for Medicare Part B. To see a 2019 Income/Premium Table please visit: https://www.cms.gov/newsroom/fact-sheets/2019-medicare-parts-b-premiums-and-deductibles


2. Part A And Part B Deductibles Are Also On The Rise:

When you utilize Medicare healthcare services, you are subject to an out of pocket deductible that must be met before your coverage kicks in. The annual deductible for Part A inpatient hospital admittance will be $1,364 in 2019. That is a $24 increase from the current year. Meanwhile the Part B annual deductible will be $185 for 2019, a $2 increase from 2018. You can read more about the Part A and B premium and deductible changes here: CMS Newsroom  

3. Medicare Advantage Is Expanding Its Scope Of Coverage:

Medicare Advantage plans often offer additional benefits that are not available through traditional Medicare, such as vision and dental care and fitness club memberships. New regulations will allow them to expand their benefits starting in 2019. Effective next year, MA plans will have the option to offer lifestyle support services including home meal delivery, home fixture safety (such as ramps and handrails), as well as transportation to and from medical appointments. Those who need assistance when it comes to the activities of daily living might also find that the cost of home health aides covered. Some services are likely to begin in 2020 after insurers have more time to implement these new regulations.

. Medicare’s Telemedicine Program Is Growing:

To address the issue of Seniors who struggle with mobility issues, Medicare offers a Telehealth program that allows patients and doctors to connect via video conference. Beginning in 2019, patients who have been diagnosed with End Stage Renal Disease or are in the midst of treatment for stroke will have access to Telehealth services.


5. Wider Variety Of Medicare Advantage Plans Depending On Location:

According to the Centers for Medicare and Medicaid Services, there will be approximately 600 new Medicare Advantage options depending on your location. More than 91% of Medicare beneficiaries will have access to 10 or more MA plans in their area.

6. The Premiums For MA Plans May Run Lower Than Average Next Year:

The premiums for Medicare Advantage plans will run an average of $28 per month in 2019, which is down from $29.81 in 2018. And there may be more plans next year with zero dollar premiums. (If you are enrolled in a MA plan, you will still have to pay your Medicare Part B premium). But you need to be aware that often times lower premium policies have smaller provider networks. It is important to make sure that your preferred doctors and hospitals are within your plan’s network so they will be covered.

7.  There will also be some changes to Part D Prescription Drug Coverage

  • Beginning in January 2019 the Medicare Part D deductible will vary. In some plans the deductible will go from $10 to $415. This means that you must pay $415 before Medicare begins to pay its share of the prescription cost. Medicare plans cannot charge more than this amount in 2019.

  • Starting on January 1, 2019, the Medicare Part D initial coverage will go from $3,750 to $3,820.  Once you and your prescription plan have hit $3,820 in 2019 for covered drugs, you’ve reached the Medicare “donut hole.” In the donut hole coverage gap, your prescription coverage is temporarily limited until you reach your out-of-pocket threshold.

  • With the Affordable Care Act and the Bipartisan Budget Act of 2018, Medicare is trying to close the “donut hole” coverage gap. Beginning in 2019, Medicare Part D enrollees will now receive a 75% discount on the total cost of their brand name drugs purchased between their Initial Coverage and their out-of-pocket threshold. Medicare will pay 63% of the price of generic drugs during the Coverage Gap.

            Items that count towards the coverage gap

  • Your yearly deductible , coinsurance, and copayments

  • The discount you get on brand-name drugs in the coverage gap

  • What you pay in the coverage gap

    Items that don't count towards the coverage gap

  • The drug plan premium

  • Pharmacy dispensing fee

  • What you pay for drugs that aren’t covered


  • In 2019, the out-of-pocket threshold will increase from $5,000 to $5,100. This is the amount of money you must pay to exit the Medicare “donut hole.” In other words, once you’ve paid $5,100 for prescriptions through your plan, you begin your catastrophic coverage benefit.

  • In 2019, the minimum cost-sharing once you’ve met your out-of-pocket threshold of ($5,100) will increase to either 5% or $3.40 for generic or preferred multi-source drugs, or to either 5% or $8.50 for all other drugs.


The more you know and understand Medicare, the better it will serve your needs. There is a lot to learn, but we mastered the art of simplifying it. Call and speak with one of our Trusted Licensed Sales Agents today!


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