For American citizens over the age of 65, access to health insurance through Medicare is a wonderful perk. Subsidized government health care can be a welcomed relief after dealing with private insurance and costly prescriptions for much of their adult lives. Perhaps not surprisingly, an AARP survey of older adults in 2018 reported that Medicare has higher rates of user satisfaction from its 58 million members than almost any other form of health insurance.
However, Medicare is not magic, and it is definitely not easy to readily understand. The multi-layered structure of Medicare comes with its own set of complicated regulations and decisions that have to be made. Different plans and coverage options make it necessary for every enrolled individual to choose certain programs for supplemental coverage, co-pay rates, “gap” plans, prescription costs, hospice services, and more.
On average, Medicare benefits pay about half of the health care expenses of its members. Individual enrollees then have to make their own arrangements to cover their outstanding costs, either with out-of-pocket funds, other insurance, or through one of the many Medicare supplemental health plans.
In general terms, Medicare offers four main sets of benefits: Medicare Part A is hospital insurance, and Part B is medical services insurance. Medicare Part D covers many prescription drugs. However, some are covered by Part B. Part C Medicare health plans, the most popular of which are known as “Medicare Advantage” programs, are another way to receive additional benefits.
Medicare Advantage plans
Medicare Advantage plans are offered through private insurance carriers approved by the government. Advantage plans differ from “original” Medicare by offering more benefits and coverage than basic Medicare. In addition to medical and hospital costs, Medicare Advantage plans may include dental insurance, prescription drugs, and hearing and vision coverage. Most Medicare Advantage plans also have a cap on how much out of pocket you will spend in a calendar year.
The growth in Medicare Advantage plans has outpaced total Medicare enrollment. In 2019, nearly 37 percent of Medicare beneficiaries will have Advantage plans. Because of that popularity and the corresponding growth in membership numbers, one of the changes for 2019 is that Medicare Advantage premiums are being lowered.
Changes coming for 2019
Each year, the program’s ruling government organization, the Centers of Medicare and Medicaid Services (CMS), recommends various modifications designed to improve existing Medicare coverage. The changes typically take effect after the first of the year and include a specified time frame for members to adjust their current coverage plans. There are several changes coming to Medicare this year, most of which involve Medicare Advantage enrollment and prescription drug plans.
Starting in 2019, the Medicare Advantage Open Enrollment period will now run until March 31 every year. That means if you are currently enrolled in a Medicare Advantage plan, you’ll have an annual, one-time opportunity to switch to a different program. If you are already in an Advantage plan, you should have received a Notice of Change document last fall, listing any changes to your particular benefits or plan rules.
The present Open Enrollment period also allows you to “disenroll” from Medicare Advantage altogether and revert to a basic Medicare Part A/Part B program. That move is often based on the desire to switch doctors (for example, if a preferred specialist isn’t included in an Advantage network). If you drop your Advantage program and choose basic Medicare coverage instead, the Open Enrollment period also gives you the chance to sign up for a separate Medicare Part D Prescription Drug Plan, which provides additional coverage for pharmaceuticals not otherwise included in basic Medicare benefits.
Another intriguing change for 2019 is the opportunity to “test drive” Medicare Advantage. New regulations allow people to try an Advantage plan for up to three months and, if not satisfied, they can switch to another Medicare Advantage option or just enroll in original Medicare.
Let a qualified adviser explain your best options
Obviously, Medicare services are complicated and can be difficult to understand. If you are considering changes to your current Medicare enrollment, or if you are approaching age 65, you should contact a professional to help work out the intricate details for you.
The experienced elder law attorneys at TuckerAllen specialize in affordable smart solutions for wills, trusts, Power of Attorney documents, and other essential aspects of estate plans, including long-term provisions for special-needs adults.
TuckerAllen also offers complimentary educational webinars, where we explain a range of estate plan options and asset protection programs, all in terms that are easy to understand.
To learn more, contact us today. You also can arrange to have an initial consultation to discuss your individual priorities.