Medicare changes for 2019

People with Medicare plans are advised to check every year to see if prices and coverage changes mean they could make a better choice. But it is particularly confusing for many trying to make a choice for 2019.

That’s because about 320,000 of the 930,000 or so Minnesotans on Medicare have been notified that their current type of plan — called Medicare Cost plans — will not be available in 2019, and they will need to choose a different type of Medicare plan during the open enrollment period, from Oct. 15 to Dec. 7.

To help understand those changes and how to compare Medicare plans, an elder law attorney and two other specialists will be at two public forums to be held in Roseville. The events are free and open to the public. They will be held Thursday, Oct. 25, from 6:30 to 8:30 p.m., at the Cedarholm Community Building at Cedarholm Golf Course, 2323 Hamline Ave. N. And on Thursday, Nov. 8, from 1 to 3 p.m., at the Roseville Library, 2180 Hamline Ave. N.

The speakers will be Brenna Galvin, an attorney with Maser, Amundson, Boggio and Hendricks in Richfield, and two insurance specialists with the Minnesota Senior LinkAge Line, which offers statewide advice and referral over the phone.

The program, called “Medicare Changes that May Affect You,” is sponsored by the Roseville Community Health Awareness Team (CHAT), Roseville Alzheimer’s and Dementia Community Action Ream (Roseville A/D), the library, Roseville Area Schools and the City of Roseville.

Galvin said she recommends that her clients review their Medicare plan annually to see if it is the best plan for them. The review could take a couple of hours and give beneficiaries peace of mind that their current choices remain good ones — or could allow them to pick a better plan that might save them significant unexpected drug or medical costs.

The biggest change this year is that Medicare Cost plans will not be available next year for many Minnesotans, including all in the seven-county metro area. They have been offered by Blue Cross and Blue Shield of Minnesota, Medica and HealthPartners.

That is because in 2003 Congress acted to phase out those plans in places where there is substantial enrollment in competing Medicare Advantage plans, but the action was delayed until 2019. In Minnesota, cost plans still will be sold, but in just 21 of the 81 counties.

Those who lose access to a Medicare Cost plan next year may instead choose to be in the Original Medicare program Parts A and B, which cover about 80 percent of medical costs; choose a Medicare supplement (Medigap) plan that for an extra premium covers some of those out-of-pocket costs; or buy a Medicare Advantage plan, which combines Original Medicare with additional coverage, often including drugs, also with an extra premium.

Some experts worry that beneficiaries who don’t make a choice will automatically receive only basic Medicare and then be surprised by high medical or prescription costs if they become seriously ill or require expensive drugs.

Many of the Medicare plans available for Minnesotans will include changes next year in monthly premiums and higher deductibles and co-payments.

But several changes will be beneficial for beneficiaries, Galvin said, including “impending closure of the donut hole (a gap in drug coverage for prescription drugs), and the repeal on the cap of outpatient physical, speech or occupational therapy.”

In the meantime, beneficiaries can compare Medicare plans by looking at the “Medicare & You” booklet mailed recently to about 700,000 Minnesota households, find a more detailed comparison on the Medicare website’s plan finder (www.medicare.gov), talk to insurance agents or seek advice from the Minnesota Senior LinkAge Line at 1-800-333-2433.

“There is no harm in reviewing your options,” Galvin said. “However, you could face economic or physical harm if you do not.”


Open Enrollment:

From Oct. 15 through Dec. 7, any Medicare beneficiary can switch plans for health care coverage that will take effect Jan. 1. 

 

Biggest changes for 2019

Medicare Cost plans will go away for about 320,000 Minnesotans, especially in the Twin Cities metro area. All beneficiaries who have a cost plan now should have been notified by the insurer and by Medicare about the change and will need to choose a new plan for 2019.

Most plans have some change in premiums, deductibles, co-payments or drugs covered.

Part D drug coverage will cover a larger percentage of drug costs in the “donut hole,” the gap in coverage after a beneficiary and insurance jointly have bought $3,820 worth of drugs and before that person spends $5,100 out of pocket. In that gap, the beneficiary now will pay 25 percent of brand-name drug costs and 37 percent of prescription drug costs. Above that level, the cost drops to about 5 percent.

 

What is Medicare?

The federal health-insurance program includes four parts.

Part A covers most costs of a hospital stay with deductibles and co-payments, but no monthly premium.

Part B covers doctor visits. It also included deductibles and co-payments and has a monthly premium that is $134 for most people (Parts A and B also are called Original Medicare).

Part C offers Medicare Advantage plans sold by private insurers. They combine Parts A and B with additional coverage, often including prescription drugs. Enrollees pay an additional monthly premium, although that is zero for a few plans that also charge higher deductibles and co-payments.

Part D is prescription drug coverage to supplement Original Medicare, Medicare supplement plans or the Part C plans that do not include drug coverage. It also has a separate monthly premium.

Medicare supplement plans cover some of the deductibles and co-payments not covered by Original Medicare and charge a separate premium.

Medicare plan-comparison online tool

You can compare plans online by going to www.medicare.gov and clicking on “Find Health & Drug Plans.” For personalized search, enter your last name, Medicare number and other information. Or you can conduct an anonymous search by entering your ZIP code.

Type in your medications, dosages and frequency. Then choose your current pharmacy.

The next page lets you choose what plans to look at: Medicare health plans with drug coverage, Medicare plans without drug coverage or stand-alone Part D prescription drug plans to supplement Medicare Parts A and B.

If you click on Medicare plans with drug coverage, for instance, you’ll get a list of those plans available in your area.

The first column lists the estimated annual drug costs. The second column shows the monthly premium and the third lists deductibles and co-payments for each tier of medications. The fourth column explains any drug restrictions. You’ll also see the plan’s overall star rating, which assesses coverage, complaints and customer service.

Check the red boxes of up to three plans and click “compare plans.” That offers a glimpse of costs and coverage. To dig deeper, click “Health & Drug Plan Benefits” to learn more about doctor, hospital and other costs. Then click on “Drug Costs and Coverage” for detail about your drug costs.

 

Where to get help

Roseville Area Senior Center, 1910 W. County Road B: In-person counseling by Senior LinkAge Line specialists is available the fourth Wednesday of the month from 9 a.m. to noon. To schedule an appointment call 651-604-3520. For other counseling sites in the seven-county area, go to www.metroaging.org/help-information/senior-linkage-line/counseling-sites.

Minnesota Senior LinkAge Line: Call the statewide information, referral and insurance-counseling service at 800-333-2433, between 8 a.m. and 4:30 p.m., Monday through Friday. 

—Warren Wolfe retired from the Star Tribune, where he wrote about aging and health care issues. He is active with the Roseville A/D.

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