Keeping Up with Medicare Changes

November 26, 2018

Here’s what you need to know for 2019.

Medicare Part A provides basic hospital insurance and is available at no charge to those who are 65 or older — if they paid Medicare taxes while working. For many, though, that amount of coverage is not enough. Some people want a Medicare supplement plan — or Medigap — to provide additional coverage for what the original Medicare doesn’t.

If you’re nearing age 65, you might wonder which supplement plan is right for you, especially if you don’t want to pay additional costs totally out-of-pocket.

Plan B, C, D, F or G; or K, L, M or N? You get the picture — it’s complicated and the rules change from time to time. In addition, some people who have low incomes can qualify for programs that reduce their Medicare-related or prescription drug costs.

Here’s what you need to know going into 2019.

What’s Not Covered by Basic Medicare

Medicare generally does not cover some of the important services that many seniors need — such as dental work, routine vision or hearing care. There are exceptions, and this is where it gets complicated.

For instance, dentures are not covered, but if you have dental work that is an emergency or is a complicated procedure, it might be covered. It’s the same situation for vision coverage. Eyeglasses generally are not covered, but if you have an eye condition such as glaucoma or cataracts, basic Medicare will cover your care.

In addition to not covering dental, vision or hearing costs, here are some additional examples of what original Medicare generally does not cover:

•    Alternative medicine (acupuncture or chiropractic services)

•    Elective cosmetic surgery; although surgeries to fix a malformation breast prostheses are covered if you had a mastectomy.

•    Long-term care (nursing home care). However, it does pay up to 100 days of skilled nursing or rehabilitation care immediately following a three-day inpatient hospital stay.

•    Personal care (help with bathing, toileting and dressing). However, it is covered if you are homebound and are also receiving skilled nursing care. Housekeeping services are covered if you are receiving hospice care.

•    Foot care. However, it will cover costs related to foot injuries or diseases.

•    Non-emergency services (copies of X-rays or most non-emergency transportation, for example).

Fidelity Investments estimates that the average, healthy couple retiring today at age 65 will spend an estimated $280,000 on health care during their lifetimes, so it’s important you have as much coverage as you can afford. Plus, if you go overseas and need care, services such as routine vision, long-term care or health services will not be covered.

Plan Options You Can Purchase

Basic, or original, Medicare consists of two parts: Part A and Part B. Remember that when Medicare covers a service or item, it usually doesn’t pay 100 percent of the cost. However, most preventive services are covered by original Medicare with no copays or deductibles.

Part A is available at no cost to seniors who have at least a 10-year work history and who register for the benefit. Part A provides coverage for hospital stays, skilled nursing, hospice and some home health services. It comes with a $1,340 deductible per benefit period and has caps on benefits.

The monthly premium for Part B is currently $134 for people with incomes up to $85,000. The monthly premium can be as high as $183 a month for those with higher incomes. After the deductible is met, you pay 20 percent of the covered services. Part B coverage is for doctor visits, outpatient services and some medical equipment.

Medicare supplement (Medigap) policies, which help cover Medicare’s co-payments, deductibles and other out-of-pocket costs, currently come in 10 standardized plans: A through D, F, G, and K through N. Medigap plans generally cover the cost of deductibles or coinsurance associated with basic Medicare and can run from about $159 to $236 for a 65-year-old male, according to the American Association for Medicare Supplement Insurance.

Medicare generally doesn’t cover long-term care. According to the American Association for Long-Term Care Insurance, a long-term care policy for a 60-year-old will be about $3,400 annually.

Recent Changes to Medigap

Here’s what you need to know about recent changes to Medigap policies.

Medigap Plan F and Plan C won’t be available to newly eligible Medicare beneficiaries after Jan. 1, 2020, but current beneficiaries will be able to keep their plans. A 2015 law prohibits insurers from selling Medigap plans that cover the Part B deductible from being sold to new Medicare enrollees starting in 2020. Plan F and Plan C cover the Part B deductible. Lawmakers hope people will be more careful when using medical care if they have to pay a deductible.

Those who like the popular Plan F are encouraged to consider Plan G, which provides most of the same coverage but doesn’t include the Part B deductible. The average premium for Plan F nationally in 2018 is $2,204 per year.

Questions? Talk to one of our brokers who specializes in Medicare and Medigap plans or call Medicare at 800-633-4227.