MEDICARE CORNER
Review, Reset… 2019 Is Here!
Official U.S. Government Site for
Medicare and Medicaid Services is:
https//www.medicare.gov
ALERT!!!
There are many websites which
appear to be the authentic Medicare
website.
Be careful when signing on you
are connecting to the Official U.S.
Government Site for Medicare. The
Official U.S. Government Site for
Medicare, paid for and managed by
the U.S. Centers for Medicare and
Medicaid Services is: https://www.
medicare.gov
NOTE: If you receive your health
care coverage from any of the following
Agencies, check with your
Human Resource Administrator,
a) before making any changes in
your healthcare or prescription drug
coverage, or b) for an explanation of
your costs sharing agencies:
• Federal Employees Health benefits
(FEHB) Program
• TRICARE
• Veterans’ Health Insurance
• Railroad Retirement Insurance
• Indian Health Services (HIS)
• Union Retiree Health Coverage
• Employee Retiree Health
Coverage
MEDICARE PARTS A/B ANNUAL
DEDUCTIBLES/PREMIUM 2019
PART B/PREMIUM/DEDUCTIBLES
Part B Standard Premiums/
Deductible = $135.50
Hold Harmless Part B Premium/
Deductible = $185
Income Related Monthly
Adjustment Amount (IRMAA)
Premiums/Deductibles for Higher
Income Beneficiaries from $189.00–
$460.00 plus Part D
PART A PREMIUM/DEDUCTIBLE
PER BENEFIT PERIOD
A benefit period begins on the
day of admission as an inpatient to
a hospital or skilled nursing facility
(SNF) and ends after 60 days
of non-hospital or SNF care, after
which a new benefit period begins.
If transferred from a hospital
to a skilled nursing facility after a
minimum of three full days as an
inpatient the Beneficiary is still in
Official U.S. Government Site for Medicare and Medicaid Services is https www medicare gov.
the same benefit period.
• Inpatient hospital deductible =
$1,364
• Daily Coinsurance for 61–90 days
= $341
• Daily Coinsurance for lifetime
reserve = $682
• Skilled Nursing Facility coinsurance
= $170.50
PRESCRIPTION DRUG COSTS
DEFINITIONS
For Additional Information Read
“Your Evidence of Coverage,”
mailed to you in 2018 by Your
Prescription Drug Plan
1.OUT OF POCKET COSTS is
what you pay when you fill a
prescription
2.TOTAL DRUG COSTS is the
total amount of the cost paid for
all covered drugs. It includes
what you pay, what family members
pay on your behalf or payments
made by specific programs
or organizations.
3.ANNUAL DEDUCTIBLE: If
your plan has a deductible you
must “meet” this amount before
your plan begins paying.
4.INITIAL COVERAGE STAGE:
Initial coverage drug costs reset
each year. The cost of your
prescription drugs may have
increased due to a change in any
of the following Coverage Rules:
• Formulary
• Tier
• Prior Authorization
• Quantity Limits
• Step Therapy
• Participating Pharmacy
5.COVERAGE GAP STAGE:
During this stage you receive a
discount on covered brand name
6.and generic drugs
7.CATASTROPHIC COVERAGE
STAGE: The plan pays most of the
cost of your covered prescription
drugs during this stage. You will
generally remain in this Coverage
Stage until the end of the year.
PHYSICAL, SPEECH,
OCCUPATIONAL THERAPY
SERVICES THRESHOLDS
Physical Therapy, Speech
Therapy and Occupational Therapy
are prescribed by a doctor and must
be medically necessary.
Physical and Speech Therapy
combined amounts in 2019 is
$2,040
Occupational Therapy 2019 combined
amounts in is $2,040
Therapy Services in excess of
$3000 for Physical and Speech
Therapy, combined and separate
for Occupational Therapy, must be
certified as Medically Necessary
through Medical Review by a
Medicare Contractor.
The $3,000 Threshold Amount
continues through 2028.
MEDIGAP PLANS C AND F (2020)
To reduce government spending
on Medicare, congress
passed a bill: Medicare ACCESS
and CHIP Reauthorization Act
of 2015 (MACRA), signed into
law in April 2015. This Law
made changes in Federal Health
Care Coverage. It requires
all persons to pay for their
Medicare Part B.
EXCEPTIONS TO MACRA
• Plans C and F pay Part B
Deductible.
• Beneficiaries currently enrolled
in Plans C and F are protected
under the Medigap Guaranteed
Renewal Clause and can keep
Medigap Plans as is.
• Eligible for Medicare prior to
2020 Beneficiaries can purchase
Plans C and F.
• New to Medicare starting 2020
Beneficiaries will not be able to
purchase Plans C and F.
• Exceptions are Beneficiaries
who are Medicare eligible due
to disability and/or ESRD prior
to 2020 and turn 65 after 2020.
They will be entitled to purchase
Plan C or F indefinitely due to
their disability.
NOTE: Medigap Increase
AARP endorsed Medigap Plans
F, G, K and N Rate Increase to be
effective April 2019
20 NORTH SHORE TOWERS COURIER ¢ March 2019
/www
/www
/www.medicare.gov
/www.medicare.gov
/medicare.gov
/7.CA
