Changes in Medicare for 2019 You Should Know

Medicare has finalized changes that will take effect in 2019. These Medicare 2019 changes are improvements meant to offer better services to beneficiaries, while they also reduce administrative burdens on various Medicare plans.

The changes are mostly on Medicare Advantage Plans (Part C) and Medicare Prescription Drug plans (Medicare Part D). It’s estimated that the changes can lead to savings of up to $295 million every year for the program.

Medicare Part C Advantage Plans Changes

• There will be a new open enrollment period for Medicare Advantage plans. This period will run from January 1 to March 31 every year starting in 2019. During this period, enrollees can switch to a new Medicare Advantage plan, drop the Medicare Advantage plan and come back to Original Medicare (Part A and Part B), or sign up or drop their stand-alone Medicare Part D prescription drug plan.
• Now health insurance carriers can offer multiple health plans within the same county even if they seem too similar to each other.
• The review process for marketing materials to beneficiaries will be streamlined.
• Some documents that Medicare Advantage carriers were required to send as hardcopy to beneficiaries can now be sent electronically. One example of this is the Evidence of Coverage document, which was previously had to be sent as hard copy through the mail. Now it can be sent through email.
• The coverage of Medicare Advantage Plans can now automatically and smoothly renew for beneficiaries each year. For those who have no desire to make changes in their Medicare Advantage Plans, no further action will be required as the renewal will be automatic.
• Some of the cost-sharing requirements of Medicare Advantage plans will be different. The changes are meant to offer more benefits for Medicare beneficiaries.
• Medicare Advantage plans may have certain medical criteria that let the plans charge different annual deductibles.
• Private carriers are no longer required to submit certain accounting info when they bid to offer Medicare Advantage plans. This may lead to more carriers offering Medicare Advantage Plans.
• Medicare Advantage plans will no longer have complete Quality Improvement Project (QIP) requirements. That’s because the Quality Improvement (QI) requirements already include the QIP activities.

Medicare Part D Prescription Drug Plans Changes

• The Medicare Prescription Drug Plans can now limit access to opioids and other types of prescription medication for certain Medicare beneficiaries who are deemed at risk for opioid addiction. However, these plans will not limit access to these drugs for patients who medically require opioids, such as some hospice and cancer patients.
• Some changes will be implemented regarding some requirements for cost sharing for generic drugs. These changes can result in lower costs for Medicare beneficiaries.
• A change in a requirement for long-term care settings will also be implemented, and this is meant to reduce the waste of medication. With this change, the quantity of the prescription drugs that Medicare Prescription Drug Plans need to supply at a single time can be reduced. So in a case that used to result in having to provide a supply of medication for 90 days, now a supply for 30 days may suffice. If the supply is not enough, then a new 30-day supply can just be provided.
• Formulary changes for medications can be more flexible. A Medicare Prescription Drug Plan can use a generic drug instead of a more expensive brand-name drug in certain cases, though the Medicare Prescription Drug Plan must still follow certain rules for these substitutions.

If you have questions, you should contact your state Medicare hotline for answers and explanations. This service is free.