Fifty-three-year-old Medicare has higher rates of satisfaction from its 60 million members than almost any other form of health insurance. The good news, according to AARP’s recent article entitled “7 Ways Medicare Will Improve in 2019,” is that it’s about to get better. The article gives us seven improvements to Medicare that will take effect in 2019. Some of the changes will affect all beneficiaries, but some will apply just to individuals who select Medicare Advantage plans. Let look at them:
The “Donut Hole.” An expensive element of the Medicare Part D prescription drug benefit requires enrollees with high prescription costs to pay more for their medicines, after they reach a spending limit in one year. This creates a coverage gap, which is called the “donut hole.” After a beneficiary’s out-of-pocket spending reaches a second mark, they go to catastrophic coverage and pay substantially less. With the Affordable Care Act (ACA), the donut hole was supposed to close in 2020. However, the spending bill Congress passed in last spring will close the donut hole for brand-name drugs next year and for generic drugs in 2020.
No More Therapy Cap. Beneficiaries of original Medicare won’t have to pay the full cost of outpatient physical, speech, or occupational therapy. That’s because Congress permanently repealed the cap that has been limiting coverage of those services.
Better Info and Tech. Medicare is updating its handbook that’s sent to beneficiaries each fall. It will have checklists and flowcharts to help with coverage decisions. The online Medicare Plan Finder tool will be easier to use and an improved “coverage wizard” will help enrollees compare out-of-pocket costs and coverage options between original Medicare and Medicare Advantage.
Increased Telemedicine. The program is expanding the availability of telehealth programs that allow patients confer with a doctor or nurse by telephone or the Internet. In 2019, Medicare will start covering telehealth services for those with end-stage renal disease or during treatment for a stroke.
Lifestyle Support. Beginning in 2019, Medicare Advantage plans have the option to cover meals delivered to the home, transportation to the doctor’s office and safety features in the home like grab bars in the bathroom and wheelchair ramps. For coverage eligibility, a medical provider will have to recommend benefits, such as home-safety improvements and prepared meals.
In-Home Assistance. Medicare Advantage plans also will have the option to pay for assistance from home health aides. These individuals assist beneficiaries with their daily activities, such as dressing, eating, and personal care. It’s a revised and broader definition of the traditional requirement that Medicare services must be primarily health-related.
Try-outs. New regulations will permit individuals try an Advantage plan for up to three months and, if they aren’t satisfied, they can switch to another Medicare Advantage plan or choose to enroll in original Medicare. Congress required this flexibility in the 21st Century Cures Act which is aimed at accelerating innovation in health care.
Reference: AARP (September 4, 2018) “7 Ways Medicare Will Improve in 2019”