2019 Medicare Advantage Plan Changes to Cost and Eligibility | MHP

Medicare Health Plans is an independent review site. However, we may earn money when you click on links on our site. Read more about How We Make Money

2019 Medicare Advantage Plan Changes

Every fall, the Centers for Medicare and Medicaid Services (CMS) finalizes changes to Medicare that will take effect the following year beginning January 1. These changes may affect your costs, your coverage, and how and when you can enroll or switch Medicare Advantage plans, so keeping up with what’s new is important to your health.

CMS publishes all these changes in several massive documents that most people don’t have time to read. Lucky for you, we pore over these documents for the Medicare plan changes that matter most. Then, we summarize important updates and break down exactly how they may affect you.

This year, CMS made its usual changes like updating premiums, deductibles, and other costs.

In addition, you may have new options for signing up for Medicare Advantage (MA) in 2019. CMS has also made improvements to its star ratings system, which could make it easier to understand and compare these additional plans.

Don’t worry. We’ll go over the most important 2019 Medicare Advantage updates and how they might affect you.

Out-of-pocket expenses

Each year, CMS adjusts premiums, deductibles, and other Medicare costs to account for inflation, available funding, and other factors.

Most expenses will increase a small amount in 2019, but your Part D costs may actually decrease. Average Part D premiums will be lower, and the federal government was able to close the coverage gap (or donut hole) a year earlier than expected

Here’s an overview of how your costs may change in 2019.

20182019
Part A1
Premium$422$437
Deductible$1,340$1,364
Daily Coinsurance For Hospital Stays
61-90 days$335$341
Lifetime Reserve Days $670$682
Skilled Nursing Facility Stay
21-100 days$167.50$170.50
Part B2
Standard Premium$134$135.50
Annual Deductible$183$185
Part C (Medicare Advantage)3
Average Premium$29.81$28
Part D
Average National Base Premium4$35.02$33.19
Maximum Deductible5$405$415
Initial Coverage Limit6$3,750$3,820
Out-of-Pocket Threshold7$5,000$5,100

In addition to Medicare Advantage premiums, Medicare Advantage beneficiaries will need to pay their Part A and B premiums if applicable to their situation.

All Medicare Advantage plans must offer coverage that’s as good or equal to Original Medicare (Parts A and B) and Part D (if you have a Medicare Advantage plan that includes Part D coverage). Essentially, that means the deductibles and copays listed in the above become the maximums Medicare Advantage plans can charge too. Your costs will be the same or lower.

To learn about other parts of Medicare, read our Medicare 101 page.

New Medicare Advantage enrollment period

This new enrollment period might be the biggest change to Medicare Advantage in 2019. It’s a big deal because it could save you from buyer’s remorse after Fall Open Enrollment.

This new period is known as the Medicare Advantage Open Enrollment Period, and will run from January 1 through March 31. It’s only for people who are already enrolled in a Medicare Advantage plan and want to do the following:

  • Switch Medicare Advantage plans.
  • Leave their Medicare Advantage plan and return to Original Medicare.
  • Add a Part D plan if returning to Original Medicare.

This new period will replace the former Medicare Advantage Disenrollment Period, which used to run from January 1 through February 14.8

All other enrollment periods, including the Annual Enrollment Period (AEP), known as fall Open Enrollment, will remain the same. As a reminder, here’s what those periods look like:

Initial Enrollment and Initial Coverage Election Periods

Your IEP begins three months before you you reach Medicare eligibility age or become eligible for Medicare in another way. It runs for seven straight months. You can sign up for Medicare Part A and B (also called Original Medicare or traditional Medicare) during your Initial Enrollment Period (IEP).

Your Initial Coverage Election Period (ICEP) happens simultaneously with your IEP in most cases. You can use your ICEP to enroll in other parts of Medicare:

  • Medicare Advantage
  • Part D

Note that even though your IEP and ICEP occur at the same time, you may have to enroll in Parts A and B before enrolling in Medicare Advantage.9

Medicare Open Enrollment

Also known as AEP, fall Medicare Open Enrollment runs from October 15 through December 7 each year. During AEP, you can do several things:

  • Change, add, or subtract plans.
  • Switch between Original Medicare and Medicare Advantage.
  • Enroll in Medicare Part D if you haven’t already.10

Special Enrollment Period

Special Enrollment Periods (SEPs) don’t occur at the same time each year. Instead, you only get an SEP in certain circumstances, such as losing some kinds of employer-offered insurance or being dropped from a Medicare Advantage plan because it no longer serves your area.11

Adding or changing Medigap plans

The first time you can enroll in a Medigap (Medicare Supplement) plan is during the Medigap Open Enrollment Period . This one-time, six-month period begins as soon as you join Medicare Part B for the first time.

During your unique Medigap Open Enrollment Period, you have the right to enroll in a Medigap plan with certain protections. Insurance companies can’t do the following:

  • Deny you coverage.
  • Charge you more due to age or preexisting conditions.
  • Make you wait for coverage.12

Your Medigap Open Enrollment Period is the best time to enroll in Medigap because you’ll get the best deal if you take advantage of the above guarantees. You can change Medicare Supplement plans at any time, but you won’t be guaranteed coverage in a new plan.

Note that you can’t enroll in Medigap if you have Medicare Advantage instead of traditional Medicare. Medigap plans help with out-of-pocket costs associated with traditional Medicare, such as Part A and B deductibles and prescription drug costs in the Part D coverage gap (known as the Donut Hole).

How to change Medicare plans during Open Enrollment

Just as CMS updates the Medicare program, many Medicare Advantage insurance companies change their plans annually as well. That makes fall Open Enrollment the perfect time to review your current health plan and see if you can snag a better deal for next year.

These annual updates also make the new Medicare Advantage Enrollment Period a great time to consider your options if you find yourself in an MA plan that isn’t working for you.

Need help choosing a Medicare plan? The easiest way to find the right plan and get enrolled is to give us a call.

Get an Advantage Plan Quote


OR

Call to speak with a licensed agent today.

855-802-1206

Switching from Medicare Advantage to traditional Medicare

Switching from Medicare Advantage to traditional MedicareIf you want to switch from Medicare Advantage back to traditional Medicare, you’ll need to drop your current plan by contacting your insurance company. Then, enroll in Medicare Parts A and B through the Social Security Administration.

If you want to add a Part D prescription drug plan or Medigap plan, our Suggest-a-Plan tool can help you choose one, and our experienced sales agents can help you enroll.

How to cancel Medicare

If you’re not happy with your Medicare Advantage plan, we recommend using Open Enrollment to switch plans or finding out if you qualify for a Special Enrollment Period before you act.

These periods are the best times to switch Medicare coverage without going uninsured during the transition.

If you want to cancel your MA plan at another time, you can do so with your insurance company, but you probably won’t be able to get a new plan until Open Enrollment. Since going without coverage for a while may result in Late Enrollment Penalties, consider your options carefully before you make that call.

In some cases, like getting a job with an employer that offers health care insurance with an HSA (Health Saving Account), beneficiaries need to drop all Medicare coverage altogether.

In this case, you’ll need to do so in person at your local Social Security office by calling 1-800-772-1213 (TTY 1-800-325-0778) to make an appointment.

Social Security will set up an interview with you to ensure you understand the consequences of canceling Medicare completely. They’ll also help make sure your new health plan includes Medicare-approved prescription drug coverage, so you don’t get hit with a Late Enrollment Penalty if you decide to get a Medicare drug plan later.

Medicare Advantage changes for dual eligibility

People who qualify for both Medicare and Medicaid (“Dual eligibles”) may be able to rest easier in 2019 if they have a Special Needs Plan that targets dual eligible people (D-SNP). In cases where an insurance company stops offering a D-SNP, CMS will now passively re-enroll affected beneficiaries in a comparable Medicare-Medicaid plan for smooth, seamless coverage.13

Changes that affect comparing Medicare Advantage plans

In 2019, CMS will allow Medicare Advantage companies to roll out several changes that may affect how beneficiaries compare and choose plans. These changes include the types of plans insurers can create, how companies market those plans, and improved quality star ratings.

Medicare Advantage Advertisements

In 2019, Medicare insurers will see looser regulations about what kinds of marketing materials need CMS approval before companies can use them. As a result, you may see more ads for Medicare Advantage plans in the mail or online.

Just remember that no matter how good a plan sounds in a flyer or on a website, that doesn’t mean it’s the right plan for you. It’s better to talk to an expert who can compare lots of plans based on your unique situation and suggest a few that may be the best fit.

More Plans on the Market

The second change that may affect how you compare and choose Medicare Advantage plans is looser regulations on what kinds of plans companies can offer.

Before, CMS insisted that every plan a company sold be significantly different from any others they offered in the same service area. This is no longer the case in 2019.

You may notice more plans on the market, and it could be more difficult to distinguish what makes one better than another. In fact, there are about 600 more Medicare Plans in 2019 than there were in 2018.14

But don’t worry. We have your back. No matter how many plans are out there, our Suggest-a-Plan tool can still help you sort through them, and our licensed Medicare Advantage sales agents can answer all your questions.

Quality Star Ratings

The CMS Star Rating system serves as a tool for gauging the quality of plans. Every Medicare Advantage and Part D plan earns between one and five stars based on customer service, patient outcomes, any complaints CMS receives, and more. CMS rewards high-scoring companies with quality bonus payments, so insurers are highly motivated to achieve five stars.

For 2019, CMS has added measures that make these rating more accurate and transparent so you can count on them even more when comparing plans.15

Other Medicare Advantage comparison factors

The updates we’ve discussed could change the way you choose your next Medicare Advantage plan, but they’re not the only factors you should consider. While no significant changes were made to the Medicare Advantage program that would affect the following elements, these  are also essential to consider:

Which providers you can use

HMOs, PPOs, SNPs, and some PFFS Medicare Advantage plans require or prefer that you get services from a pre-approved network of doctors, hospitals, pharmacies, and more.

Staying within these networks keeps costs down for both you and the company, but if you’d rather stick with your family doctor or someone closer to home, you may want to choose a different plan.

Where you can get services

Speaking of seeing doctors closer to home, what if you plan on calling more than one place home in 2019? If you’re like many retirees who plan to travel a lot either internationally or domestically, you may want a plan that covers you outside your hometown.

Other coverage you already have

If you have health insurance through an employer or another organization, you may not need as many bells and whistles with your Medicare Advantage plan. Downsizing could save you some cash without compromising your care.

The takeaway

If you’re considering switching up your Medicare coverage, annual changes can complicate your choices. But don’t worry—you’re not in this alone!

Talk to a licensed agent who can answer your questions, narrow your options, and help you enroll. Give us a call today at 855-802-1206. We can help take some of the pressure off you.

Sources:

  1. CMS.gov, “Medicare Costs at a Glance
  2. CMS.gov, “Medicare Costs at a Glance
  3. CMS.gov, “2019 Medicare Advantage and Part D Prescription Drug Program Landscape
  4. CMS.org, “Part D Late Enrollment Penalty
  5. CMS.gov, “Yearly Deductible for Drug Plans
  6. CMS.gov, “Costs in the Coverage Gap
  7. CMS.gov, “Catastrophic Coverage
  8. CMS.gov, “CMS Finalizes Policy Changes and Updates for Medicare Advantage and the Prescription Drug Benefit Program for Contract Year 2019 (CMS-4182-F)
  9. NCOA.org, “Medicare Advantage: Enrollment and Disenrollment Basics
  10. CMS.gov, “Medicare Open Enrollment
  11. Medicare.gov, “Special Circumstances (Special Enrollment Periods)
  12. Medicare.gov, “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare
  13. CMS.gov, “CMS Finalizes Policy Changes and Updates for Medicare Advantage and the Prescription Drug Benefit Program for Contract Year 2019 (CMS-4182-F)
  14. CMS.gov, “2019 Medicare Advantage and Part D Prescription Drug Program Landscape
  15. CMS.gov, “CMS Finalizes Policy Changes and Updates for Medicare Advantage and the Prescription Drug Benefit Program for Contract Year 2019 (CMS-4182-F)

This site is a U.S. Consumer site. You can learn more about our site and privacy policy here.