Medicare Advantage Plans May Offer New Supplemental Benefits,
But New Co-Pay “Tiers” May Raise Some Costs
Enrollees in Medicare Advantage (MA) plans should take a careful look at changes in their health plan for 2019. These Medicare health plans have new leeway to offer new supplemental benefits. While some of the new benefits may be valuable to some families, other changes, which give plans greater leeway to “tier” the co-pay structure for healthcare providers, may mean higher out-of-pocket costs when non-preferred or out-of-network providers are used.
In the past, supplemental benefits offered by MA plans were only required to be primarily health related and typically included dental, hearing or vision benefits. Starting in 2019, new supplemental benefits must be medically appropriate and recommended by a licensed provider as part of a care plan, and not offered simply to induce enrollment. Examples of the new supplemental benefits include adult day care services, in-home support services, home and bathroom safety devices, transportation, and home-based palliative care. However, to qualify for these benefits, you must be diagnosed with a condition for which these benefits are necessary, and the benefits must be listed by your physician as part of your plan of care.
Medicare health plans also have new rules about co-pays and co-insurance. Copayments can vary drastically between MA plans, but through 2018, individual plans were required to offer all enrollees in the plan’s service area access to the same benefits at the same level of cost - sharing. In 2019, MA plans have the option of imposing tiers for the cost - sharing of contracted providers, as an incentive to encourage enrollees to seek care from specific providers. Plans that utilize tiered cost-sharing must disclose tiered co-pays and co-insurance amounts to enrollees and providers, ensure that services at each tier of cost-sharing are available to all enrollees, and ensure that all enrollees are charged the same amount for the same service from the same provider.
The annual Medicare Advantage Open Enrollment period starts January 1 –March 31. During this time, you will be allowed to switch to another MA plan or return to Medicare and a stand alone plan. However, if you give up your MA plan in favor of returning to original Medicare, that does not necessarily mean you would be able to buy a Medigap supplement. Medicare supplement insurers are not required by law to cover pre-existing conditions, other than during certain periods (when you first sign up for Part B or if you qualify for a Special Enrollment Period.)
If you have questions about your coverage, Medicare beneficiaries can get free one-on-one counseling from State Health Insurance Program (SHIP) counselors by contacting your local Area Agency on Aging or senior center. The programs go by different names depending on your location, but SHIP contact info can be found at https://www.shiptacenter.org.
Source: “2019 Changes to Medicare Advantage and Part D,” The National Council on Aging, accessed on October 4, 2018.