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Learn » Medicare » Medicare Rule Changes in 2020

Medicare Rule Changes in 2020

What's new for people with Medicare as 2019 comes to a close?

October 4, 2019 - By Walecia Konrad - read

Researched by licensed + unbiased insurance experts. Learn More

As open enrollment season for Medicare draws near, be sure to take next year’s rule changes into account as you consider your options.

Starting October 15 and ending December 7, people with Medicare will have a chance to change plans or stick with their existing coverage. Even if you are happy with your current Medicare coverage, it’s important to reevaluate and compare the alternatives. Individual plan costs and benefits can change often. These Medicare rule changes that will take effect in January may impact your decision.

Here’s what you need to know to help find the Medicare coverage that’s best for you.

New Medicare Advantage (Part C) Benefits in 2020 and Beyond

Starting last year, new government rules allowed Medicare Advantage plans to significantly increase the types of benefits they cover beyond strict medical care. Medicare Advantage plans are sold by private insurers who offer the same coverage as Original Medicare. These plans often offer extra benefits such as vision and dental.

The new rules opened the door to coverage of services such as adult daycare, home-based care, caregiver support, pain management and safety devices. Although the rule changes came late in the year in 2018, few insurers had time to integrate these changes into their 2019 plans before the October 1 filing deadline.

#Medicare Advantage members are eligible for a wider variety of additional benefits than ever before. Click To Tweet

This year, however, a large number of Medicare Advantage plans are expected to include the additional benefits. In addition, a separate government ruling has allowed even more non-medical benefits for plan year 2020, especially for people with chronic illnesses.

According to data from Medicare Advantage insurance company filings outlining their 2020 plans reported in the Washington Examiner, insurers are offering coverage for a broad range of services including grab bars, nutritional advice, rides to doctor appointments, acupuncture, massage therapy and service animal support.

Keep in mind, however, that unlike the uniform medical coverage offered to everyone enrolled in any type of Medicare plan, these expanded benefits are not available to everyone. Before you sign up for one of these expanded plans, be sure you know the limits involved, warns David Lipschutz, senior policy attorney at the Center for Medicare Advocacy.

Medicare Part D 2020 Changes: Higher Prescription Drug Out-of-Pocket Costs

Enrollees will no longer face Medicare Part D gap in coverage known as the doughnut hole — when Medicare beneficiaries paid total costs for prescription drugs after a certain limit. But some Medicare recipients, especially those who need expensive drugs, may still face higher out-of-pocket costs.

That’s because the so-called catastrophic threshold, the limit that Medicare recipients pay out-of-pocket for prescription drugs, is rising from $5,100 in 2019 to $6,350 in 2020. Once patients hit the catastrophic threshold, they only need to contribute a 5 percent copayment for all medicines for life.

The higher catastrophic threshold means beneficiaries will pay their usual 20% copays for medicines for a longer period of time. #Medicare Click To Tweet

There’s no getting around the new limit, but Medicare beneficiaries should heed some basic advice to make sure they receive insurance coverage for the prescription drugs they need.

Most important, look for changes in your Medicare prescription drug plan. Don’t assume that your plan’s formulary, the list of prescription drugs covered by your Part D or Medicare Advantage plan, is permanent. These lists change every year.

Before the October 15 Annual Election Period, you should receive a notice of plan changes. Be sure to check this document carefully or call your insurer to determine if your medicines are still covered, advises Leslie Fried, senior director of the Center for Benefits Access at the National Council on Aging.

Changes to Medigap in 2020

Many people who choose Original Medicare instead of Medicare Advantage purchase Medicare Supplement insurance, also known as Medigap. There are 10 active Medigap plan types, which are identified by letter – like Plan D, Plan K, or Plan M. Medigap helps cover premiums, copayments and additional out-of-pocket costs that Original Medicare doesn’t cover.

Under new rules, Medigap Plans C and F will no longer be available for people who are enrolling in Medicare for the first time on or after January 1, 2020. These two plans had been very popular, since they’re the only two options that still cover the Medicare Part B deductible ($185 per year in 2019).

People eligible for #Medicare after 2019 will need to look away from Plan F. Other Medigap plans supplement Original Medicare costs in similar ways. Click To Tweet

If you are already enrolled in a C or F plan, you will still be covered for life. There is no need to take action if you are happy with that coverage. Plan F members may save money by switching to a growing plan like Plan G, however.

By the same token, if you enrolled in any type of Medicare before January 1, 2020 you can still join Plan C or Plan F in the future, assuming you qualify. Only people new to Medicare are affected. “These plans are not going away, they are not being eliminated and people in them do not have to make any changes,” says Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center.

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