The New Face of Medicare

There are a number of significant improvements to Medicare, taking effect in 2019, that members, and soon-to-be members, should be aware of.

Closing the “Donut Hole.”  The Medicare Part D prescription drug benefit required members with high prescription costs to incur additional costs after a certain level of spending was reached in one year.  This became known as the “donut hole”.  Under the Affordable Care Act, the hole has been narrowing each year and would have closed completely in 2020.  But the Congressional spending bill passed in March of this year will close the hole, for brand name drugs, in 2019.  Beginning in 2019, Part D enrollees will pay 25 percent of the cost of all their prescription drugs from the time they enter the gap until they reach catastrophic coverage (spending $5,000 out of pocket).

Eliminating the therapy cap.  For 20 years, the benefit for the cost of physical, speech and occupational therapy has been capped at $2,010.  Periodically, Congress would pass exceptions to the cap for services judged to be medically necessary. The result has been confusion for the 6 million members who are estimated to use outpatient therapy services.  The cap has been permanently eliminated for costs incurred in 2019.

Providing user-friendly information.  The Medicare Handbook that is published each fall has been upgraded, with flowcharts and checklists, designed to help members in selecting the best coverage.  In addition, there is a new on-line tool, the “Medicare Plan Finder.”  This will help members compare original Medicare and Medicare Advantage in terms of coverage options and out-of-pocket costs.

Embracing telemedicine.  Medicare is slowly beginning to cover medical services provided through tele-health programs.  For example, tele-health services provided for the treatment of stroke will now be covered.

Expanding benefits for lifestyle support and in-home assistance.  Medicare Advantage plans will now have the option to cover such services as: meals delivered to the home; transportation to the doctor’s office; home safety features; and home health aides.

Allowing for flexibility in plan selection.  Members will be able to try out an Advantage plan for three months.  If now satisfied, members can then switch to another Advantage plan or enroll in original Medicare.

Issuing new, more secure ID cards. Starting in 2018, Medicare began issuing new cards to members.  These cards no longer carried the member’s Social Security number, but instead carried a unique ID number.  As noted in a previous blog on Medicare fraud, these new cards are being issued a no cost to members.


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