Medicare in 2019: What to Expect?

medicare : What to expect?

Most people know that every fall Social Security sets new rates for Medicare premiums, copays, and coinsurance in the following year. In some years that’s all that really changes, but in 2019 we also have some additional changes that can really benefit Medicare beneficiaries.

Let’s take a look at some of the most important Medicare changes for 2019.

A New Open Enrollment Period

Some years ago, there was an open enrollment period that existed each year from January 1st – March 31st and affected only people enrolled in Part C Medicare Advantage plans.

During this window of time, beneficiaries could make one change from their current Advantage plan. They could either change to a different Medicare Advantage plan or they could return to Original Medicare and add a Part D drug plan.

The Affordable Care Act legislation did away with this period and so in recent years, it was replaced with a Medicare Advantage Disenrollment Period which lasted from January 1st – February 14th. However, this revised election period only allowed beneficiaries to return to Original Medicare. They couldn’t change from one Advantage plan to another.

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Almost as soon as the OEP was taken away, various groups because lobbying Congress to reinstate it. The reason is that Medicare Advantage plans have some tricky features that make them operate very differently from Medigap plans, and many beneficiaries don’t realize.

These plans have networks so it’s important to make sure that your doctors and hospitals are in the network before you join the plan. Many plans also include a Part D drug plan, so it’s important that beneficiaries considering a plan check the drug formulary to make sure that the plan covers their important medications.

If beneficiaries don’t know this and they use the Annual Election Period in the fall to elect a new Medicare Advantage plan, they might discover in January, after they are already locked in for the calendar year, that another plan would have been better for them.

Fortunately, all the lobbying efforts worked and January 1 – March 31 Open Enrollment Period has been reinstated. This will give beneficiaries more flexibility in changing their plans if they decide in the new year that the plan, they chose isn’t what they expected.

TIP: If you use the new OEP to disenroll from a Medicare Advantage plan and return to Original Medicare, be aware that this does not necessarily give you a guaranteed issue period to enroll in a Medicare supplement without answering health questions.

Since you may have to answer health questions and pass medical underwriting to be issued a Medicare supplement, you should always apply for the Medicare supplement first and make sure you get approved before disenrolling in your Medicare Advantage plan.

New Medicare Advantage Plan Benefits Allowed

One of the things that new beneficiaries are often surprised to learn is that Medicare does not provide for long-term care. While it provides medical insurance benefits to people while they are living in a long-term care facility, it doesn’t cover the cost of the facility itself.

Furthermore, Medicare also usually doesn’t provide custodial care at home for beneficiaries needing help with activities of daily living such as bathing or dressing.

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However, beginning this year Medicare Advantage plans can now include some supplemental benefits that do fall into the realm of custodial and long-term care. Congress approved for these benefits to be included especially in cases of patients with multiple chronic illnesses.  

The idea is that if some of these benefits were provided, then many patients could continue living independently at home for a longer period before needing to move into an assisted living or long-term care facility.

Some of the new benefits that plans may begin to build in are adult day-care services and/or in-home help with performing activities of daily living.

Plans can also now pay for meal delivery, transportation to and from medical appointments and home safety modifications such as ramps for wheelchairs and scooters or bathroom grab-bars. There are also additional respite benefits allowed for full-time caregivers.

TIP: Keep an eye out for more of these benefits in 2020. Plans were a bit slow to take up these benefits in 2019, but we expect to see more of them built into the 2020 plans and beyond, and these could be deciding factors in which plans you choose to enroll in

Ordinary Increases

As we mentioned earlier, Social Security generally announces new rates for Medicare each year. Here are some of the changes to premiums, deductibles and copays next year.

Part A deductible has increased to $1364 per benefit period. For long stays in the hospital, daily hospital copays have increased to $341/day for Day 61 and $682/day for Day 91 and beyond. Benefits still run out at Day 150 though – that has not changed.

If the beneficiary has a stay in a skilled nursing facility, the first 20 days are still covered by Medicare Part A, but the daily copay for Days 21 – 100 has increased to $170.50/day.

The Part B deductible has increased from $183 to $185 in 2019, but the Part B coinsurance remains as before at 20%. Part B is outpatient coverage and unlike Part A, which most beneficiaries pay $0 for, Part B has monthly premiums which beneficiaries pay for.

These premiums are generally deducted from your Social Security check each month, although it is billed quarterly to beneficiaries who are on Medicare but have not yet signed up for Social Security income benefits.

In 2019, the standard base premium for Part B has increased to $135.50 per month. Most beneficiaries pay this amount, although some low-income beneficiaries may qualify for a Medicare Savings Program that helps to pay for some or all of this premium.

Around 5% of beneficiaries are considered high-income earners, and these people pay more for Medicare Part B. In 2019, a new income tier was added which substantially increased the cost of Part B for people in the highest income brackets. Individuals earning more than $500,000 annually or married couples earning more than $750,000 will now pay $460.50/month for Part B.

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Lastly, people who enrol in Medicare Part D drug plans may have noticed that the Part D deductible has increased from $405 to $415. While some Part D plans waive the deductible or charge a lesser deductible, many of the most common plans to utilize the full $415 deductible.

If you enrolled in a plan with this deductible, just be aware that you’ll pay this amount out-of-pocket on your medications until you reach the deductible, and then your copay benefits in the initial coverage level will kick in.

Danielle K Roberts is a Medicare insurance expert and co-founder at Boomer Benefits where she and her team help baby boomers navigate their entry into Medicare. You can learn more at

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