MEDICARE CORNER
Photos by Dawn Steinberg
NOTE: If you receive your health
and/or prescription drug coverage
from the following agencies check
with your human resource administrator
for explanation of your
benefits, coverage and costs.
• Federal Employees Health
Benefits (FEHB) Program
• Tricare
• Veterans’ Health Insurance
• Railroad Retirement Insurance
• Indian Health Services (IHS)
• Union Retiree Health Coverage
• Employee Retiree Health
Coverage
NOTE: Check with your human
resource administrator if you are
currently enrolled in a retiree cost
plan from Hip/Emblem. The plan
is being discontinued 2019.
Take time now from your busy
schedule to review your coverage
and see if you need to make
any changes before the Open
Enrollment Period ends Friday,
December 7, 2018.
DO A QUICK CHECKLIST REVIEW
OF THE FOLLOWING:
• You received your Annual
Notice of Change (ANOC) and
Evidence of Coverage (EOC)
from your Health Insurance and
or Prescription Drug Company.
• The Annual Notice of Change
provides information on projected
changes in your Health Care
Coverage and Costs for 2019.
• The Evidence of Coverage provides
information on projected
changes in your Prescription
Drug Coverage, such as formulary
and other prescription drug
restrictions.
• The Creditable Coverage Notice
informs you if your prescription
drug coverage is as good as or better
than a standard Medicare Part
D Plan. END BULLETED LIST
F YOU’RE LOOKING FOR A
DOCTOR, ASK THE FOLLOWING
QUESTIONS:
• Do you participate in Medicare?
• Do you accept Medicare
ITALIC in full END ITALIC?
• With which hospitals are you
affiliated?
• Do you have admitting privileges?
KNOW IF YOU ARE AN INPATIENT
OR AN OUTPATIENT:
Part A covers Inpatient Services
and Part B covers Outpatient
Services.
If you are in a hospital for more
than 24 hours, the hospital is
required to give you a “Medical
Outpatient Observation Notice
(MOON).” This form informs you
that you are receiving Outpatient
Observation Services rather than
Inpatient Services and explains
how it affects your cost sharing and
Part A coverage, if you are transferred
to a Skilled Nursing Facility.
Request the MOON Form if you
have not received it after 24 hours
of being in the Hospital
ORIGINAL MEDICARE COSTS 2019
Medicare Part A Cost-Sharing
A benefit period begins on the
day you are admitted as an inpatient
to a hospital or a Skilled Nursing
Facility (SNF). The benefit period
ends if you haven’t received any
services in a hospital or SNF for
60 consecutive days.
• Part A Deductible per benefit
period = $1,364
• Part A Co-payment per benefit
period = $341 per day for
days 61-90
• Part A Skilled Nursing Facility
Co-payment per benefit period
= $170 per day for days 21-100
Medicare Part B Cost-
Sharing 2019
• Social security 2019 Cost-Of-
Living Adjustment (COLA)
= 2.8%
• Medicare pays 80% of what
Medicare approves
• Beneficiaries cost sharing is usually
20% co-insurance
• Annual Deductible = $185
• Standard Monthly Premium =
$135.50 END BULLETED LIST
Except for:
• “Hold Harmless “ Beneficiaries
• Higher Income Beneficiaries
MEDIGAP PLANS 2019
• Plans K and L increase in Outof
Pocket Limits.
• Increase in deductible for High
Deductible Plan F
• AARP United Health Care
Medigap Insurance increase for
Plans F, G, K and N
MEDICARE ADVANTAGE (MA)
PLANS: HMO/PPO COSTSHARING
2019
Beneficiaries Cost Sharing
for MA Plans depend upon the
Plan. Review your EOC and
ANOC or call your MA Customer
Services for explanation of Cost-
Sharing 2019.
Some MA Plans have added
additional options and cost sharing
such as:
• Home Delivered Meals following
surgery/hospital stay
• Durable Medical Insurance 20%
co-insurance
• More plans offering additional
optional riders
MEDICARE PART D COSTSHARING
2019/2020
Part D Coverage Gap (Donut
Hole) being eliminated for brand
name drugs in 2019 and for generic
drugs in 2020.
DURABLE MEDICAL
EQUIPMENT 2019
Starting 2019, Beneficiaries
can use any Durable Medical
Equipment (DME) supplier
enrolled in Medicare. If DME supplier
does not “accept assignment,”
Beneficiaries are not protected
under limiting charges.
Okay, You’re Busy Already!
Hannah addressed residents in the Coleridge Lounge during a recent
Medicare Seminar
Medicare consultant Hannah
28 NORTH SHORE TOWERS COURIER ¢ December 2018