Health & Fitness

If you’re joining Medicare for the first time, you’ll have to pay an annual deductible now

There’s one thing you can count on when you’re dealing with Medicare. By the time you figure out the system, it will change. That’s the cautionary message of many a government administrator, beneficiary and volunteer —- and there are indeed more changes coming, starting on Jan. 1.

The major differences will primarily impact those who are new to the government health insurance program. People new to Medicare are those who turn 65 on or after Jan. 1, and those who first become eligible for Medicare benefits due to other factors such as disability or end stage renal disease on or after Jan 1.

The MACRA or Medicare Access and CHIP Reauthorization Act, signed into law in 2015, includes revisions that will take effect in all states.

As of March, 38 million people were enrolled nationwide in the “Original Medicare” program and nearly 23 million enrolled in Medicare Advantage or other Medicare health plans — about 61 million in the country, said Anne Chansler, statewide program director for SHINE and Senior Medicare Patrol.

Listen to today's top stories from the Miami Herald:

SHINE stands for Serving Health Insurance Needs of Elderly, a nonprofit program run by the state Department of Elder Affairs and the Florida Area Agency on Aging. About 500 volunteers statewide help residents navigate the Medicare program through SHINE. There’s a big need for help in Florida. As of 2015, there were an estimated 4.8 million residents 60 and over in the state.

Read Next

As you navigate Medicare, know the basics: Original Medicare (Part A) covers hospital-based care. If you’ve worked and paid taxes for at least 10 years, you won’t have to pay a monthly premium for Part A, although there is a deductible.

Part B of Original Medicare covers visits to your doctor’s office, outpatient care, preventive services and medical supplies. This part does require a monthly premium and deductible. The 2020 cost of Part B premiums “will be released later this year,” said a spokesman for the Centers for Medicare & Medicaid Services or CMS.

Medicare Parts A and B don’t cover all a person’s needs such as routine dental care, eyeglasses, hearing aids, prescription drugs and longer periods of rehab, so most people buy supplemental insurance. Medicare Supplement Insurance policies are also called Medigap policies. Every Medigap policy must follow federal and state laws and they’re identified by different letters.

The big change coming is that Medigap Plans C and F will no longer be available to people new to Medicare starting on Jan. 1. That’s because both those plans covered the Part B deductible, which is $185 in 2019. Medigap Plan C did not cover excess charges but Medigap Plan F did cover 100 percent of a person’s medical bills, both the copays and the $185 deductible.

Congress, in passing that 2015 law, figured that if you had people paying an out-of-pocket deductible, they would be more judicious in using Medicare.

“Right now, the Medigap ‘F’ policy covers everything a Medigap Supplement could cover,” said Kathleen Sarmiento, SHINE liaison for the Alliance for Aging. “It’s the Cadillac of the supplement plans and it’s going away.”

Anyone enrolled in a Medigap Plan C or Medigap Plan F as of Dec. 31, 2019, will be “grandfathered” in and will be able to continue with their plan, Sarmiento said.

For those newly enrolled, they will have to seek another Medigap coverage plan.

New applicants are likely to consider Medicare Supplement Plan G, which has the same basic benefits as Plan F, except the person would have to pay the Part B annual deductible starting Jan. 1. The Plan B deductible is expected to increase to $197 for 2020.

Changes to the Medicare system primarily impact people who are covered under Original Medicare, said David Bruns, Florida AARP director of communications. The Medigap plans work in tandem with Original Medicare.

Medicare Advantage plans

Medicare Advantage is another way to get Medicare coverage and includes Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service and Special Needs Plan coverage. It incorporates both Medicare A and B.

Four of 10 Floridians 65 and older are on Medicare Advantage, said Bruns.

Drug plan changes in 2020

Prescription drug costs will also be impacted in 2020. One change to Plan D, the prescription drug Medicare plan, involves the so-called “donut hole.” explains that the coverage gap or “donut hole” begins when you exceed your plan’s Initial coverage limit. This is the portion of your Medicare Part D coverage where you pay a larger percentage of the retail drug cost.

The 2019 Donut Hole discount is 75 percent for brand-name drugs and 63 percent for generic drugs. Beneficiaries currently pay a 25 percent copay for brand-name drugs and 37 percent for generic drugs, but under the new changes the copay for generic drugs will be reduced to 25 percent.

Under Medicare Part D, the drug plan, when individuals reach the out-of-pocket spending limit, which will be $6,350 in 2020, they will enter the catastrophic phase of the Part D benefit to cover high-priced drugs, according to CMS.

If a Medicare recipient has limited income and resources, they can try to qualify for Medicare’s “Extra Help” program.

Read Next

New Medicare cards

Among other changes, officials also urged recipients to be sure they have new Medicare cards. The Centers for Medicare & Medicaid Services has removed Social Security numbers from all new cards to help prevent fraud.

Instead, the new cards have a number called a Medicare Beneficiary Identifier. Medicare recipients can no longer use the old card after Jan. 1, 2020, so anyone who hasn’t received a new one should contact 1-800-Medicare, said SHINE’s Chansler.

“Don’t throw the old cards out in the trash because it has that Social Security number on it,” she said.

Like any aspect of choosing your coverage,“make all Medicare choices after carefully considering what your health situation is,” said Bruns. “Even if you’re healthy, the lowest cost plans may have the fewest benefits. It’s a roll of the dice. If you’re dealing with a chronic condition like diabetes, a heart condition or treatment for cancer, then cheap insurance is the most expensive insurance you can buy.”