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How Medicare is Changing: What You Need to Know

by Melissa Bell
6 minutes read

Every year Medicare makes some small change. It’s normal to see that the monthly premiums for Part B will go up slightly and/or Medicare increases the deductibles for Parts A, B, and D.

However, in 2019 there are quite a few other changes that you’ll want to be aware of as it may affect your decisions about how you access your benefits.

These are some of the primary changes to be aware of.

doctor and paitient

New Features and Benefits Inside Medicare Advantage Plans

When a beneficiary enrolls in Medicare, they can choose to get their benefits through Original Medicare, or they can choose to enroll in a local Medicare Advantage plan. Traditional Medicare covers medically necessary services but usually does not cover routine things like dental, vision, hearing benefits. Until now, Medicare has also not covered home health care services unless certain circumstances are met and still won’t. However, Medicare did announce that in 2019, Medicare Advantage plans could begin to include some home health type benefits in their plan designs.

For example, a plan may offer home safety modifications such as wheelchair ramps or bathroom grab bars. They can also cover in-home support services so that seniors can get help with activities in their day to day lives. The carriers are even allowed to cover adult day care services.

Because this change was not announced until April of 2018, many plans did not have time to get these new benefits built into the 2019 plans. Less than 300 plans now include them. However, we expect that for 2020 we will likely see quite a few more jump into offering these benefits and this may lead to increased enrollment into Medicare Advantage plans. You can review new plan options in your area beginning in October on Medicare’s website.

taking medication

A New Open Enrollment Window for Part C Plans

Medicare has a variety of enrollment periods for all sort of different things. For example, there is an Initial Enrollment Period during which a person turning 65 should sign up for Medicare Parts A and/or B. There is also an Annual Enrollment Period in the fall during which beneficiaries can make changes to their drug plans or their Medicare Advantage Plans.

However, in 2019, Medicare brought back a previously discontinued period called the Medicare Advantage Open Enrollment Period. This period allows any beneficiary who is enrolled in a Part C Medicare Advantage plan to drop their coverage and either return to Original Medicare or switch to a different Medicare Advantage plan.

This window runs from January 1st to March 31st each year and can only be used once during that window of time. The reason this period is important is that every year during the Annual Enrollment Period in the fall, millions of seniors enroll in Medicare Advantage plans. Unfortunately, some of them are not fully aware of how the plans work and they don’t realize this until January when they begin using their benefits.

They could learn that their doctor isn’t in the plan’s network or that one of their medications are not covered on the plans drug formulary. Ordinarily, they would be stuck in this plan through the entire calendar year. Fortunately, this new enrollment period will allow them to make a change.

If a beneficiary uses the period to return to Original Medicare, they may lose a built-in Part D drug plan that was part of their prior Advantage plan. Medicare will allow them to enroll in a standalone Part D drug plan to go alongside their Original Medicare benefits.

Changes to the Part D Donut Hole

When Part D was created, Congress built in a coverage gap or donut hole. When a beneficiary’s drug spending goes over a certain amount each year, they can fall into the donut hole, at which point the cost of their drugs has gone up.

The donut hole has been slowly closing for some time and now in 2019, the percentage that the beneficiary pays for brand name drugs in the gap is only 25%. They pay 37% for generics in the gap, although this will also come down in 2020.

This was good news for many seniors who struggle to pay for expensive brand name drugs when they hit the gap.

walking frame

Cost Plans Have Been Largely Discontinued

In some areas, Medicare beneficiaries have been able to enroll in something called Medicare Cost plans. These plans are a hybrid that offers Medicare Advantage coverage but also still allow members to use Original Medicare benefits if they need to see a provider that isn’t in the plan’s network.

As Medicare Advantage plans have grown and expanded their networks into more rural areas, the need for Medicare Cost plans has diminished. Most counties now offer multiple Advantage plan option to beneficiaries who reside there. This caused a whole bunch of areas to discontinue their Cost plans.

While these plans were offered in as many as fifteen states, there was a large population of Cost plan members in Minnesota. Many of these members’ plans were discontinued and they had to choose new coverage. Medicare allowed them to either return to Original Medicare and get a Medigap plan or to choose a Medicare Advantage plan in their area.


It’s been a long time coming but the Centers for Medicare and Medicaid Services have finally begun to allow telehealth benefits in some situations. This change is expected to modernize the Medicare healthcare system and help people in rural areas have better access to their providers.

Medicare has designated certain areas, called Originating Sites, where a beneficiary can see their provider via telecommunications. Patients will be able to use this new benefit for telehealth services delivered by physicians, nurse practitioners, physician assistants, and other types of medical providers.

What’s Next

We can be sure that there will be some changes in 2020 as well. One that we know about now is that Medicare is discontinuing Medigap plans C and F as of January 1st of 2020. Beneficiaries who become eligible for Medicare on or after that date will no longer be able to buy those plans.

Beneficiaries who were eligible for Medicare prior to that date will always be able to buy Plans C and F but some are speculating that these plans will slowly disappear over time. There is also concern that people already on these plans will see rate increases once new beneficiaries can no longer buy them.  It remains to be seen so stay tuned

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