2019 Means Changes to Medicare Advantage and Part D

calendar reads 2019 over blue background with pills

On April 2nd, the Centers for Medicare and Medicaid Services (CMS) noted several changes to Medicare Advantage and Medicare Part D in a 1,156 page letter. The changes are set to take place January 1, 2019. Here are some of the highlights.

  1. Prescriptions. Previously, prescriptions for Medicare Advantage (MA) and Part D must have been written by a prescriber contracted with Medicare. Now, prescribers not contracted with Medicare can write prescriptions for MA and Part D beneficiaries.
  2. Preclusion list. CMS created a “preclusion list” of providers and suppliers whose practices do not align with the interests of Medicare. Medicare will now no longer pay for services and supplies rendered by those on the preclusion list.
  3. Donut hole. The Medicare donut hole discount will increase to 75% in 2019. The pharmaceutical industry will be responsible for 70% of the cost of while Medicare will cover the other 5%. That means 95% of brand-name drug costs will count towards your total out-of-pocket spending, allowing you to reach catastrophic coverage sooner.
  4. Extra Help. Medicare beneficiaries eligible for Extra Help will only be able to change Part D plans once per quarter during the first 9 months of the year.
  5. Medicare Advantage Disenrollment Period. Beginning next year, Medicare will do away with the Medicare Advantage Disenrollment Period (January 1 – February 14) and instead have Medicare Advantage Open Enrollment from January 1 – March 31. During this time, Medicare Advantage beneficiaries can switch MA plans, leave and go to a Part D plan, or leave and go to Original Medicare.

infographic of changes to medicare advantage and medicare part d in 2019

Stay tuned to Medicare World for more updates on changes to Medicare in 2019.

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