2019 Medicare Part D Preview

2019 Medicare Part D Preview

President Trump Ends Donut Hole for Part D Enrollees

Seniors, Medicare plan providers, and caregivers can expect a few changes in the 2019 Medicare Part D program. Medicare beneficiaries with high annual prescription drug costs will get some relief a year earlier than expected because of the budget deal President Trump signed for 2019. Congress made the early close of the donut hole possible by requiring certain pharmaceutical manufacturers to pay more of the costs for enrollees who are in the coverage gap.  Currently, brand-name drug makers pay 50 percent of enrollees’ brand name drug costs while they are in the coverage gap. Under the 2019 budget law, pharmaceutical manufacturers will now pay 70 percent while the plan will be responsible for the 5 percent discount.

The donut hole has been narrowing each year since the Affordable Care Act (ACA) passed in 2010. The gap was scheduled to close in 2020, when beneficiaries would be expected to pay 25 percent of the cost of all their prescriptions while they were in the gap.  Beginning in 2019, Part D enrollees will pay 25 percent of the cost of all their prescription drugs from the time they enter the gap until they reach catastrophic coverage.

A part D enrollee will enter the donut hole or coverage gap when the retail costs of their medications reach $3,820 in retail dollars and the donut hole exit point is $5,100. Upon reaching the catastrophic phase, the part D enrollee will only pay 5 percent of the retail costs of the drug. 

For 2019, part D enrollees will see an increase in their part D annual deductible.  Plans offered in 2018 had a $405 annual deductible and for 2019, this deductible may rise to $415. On the average, we can expect to see a slight decrease in premiums.  Researching your 2019 Medicare Part D options should be on your “to do” list during October 15 through December 7 annually.  Deductibles, premiums, copays, and plan formularies change from year to year.  Take advantage of open enrollment counselors at 1-800-633-4227 (Medicare) or your local SHIP office.  Your regional SHIP office benefit counselors offer unbiased advice based on your individual needs and may be reached by calling locally at 864-242-9733 or by calling toll free at 1-800-434-4036. You may also research using www.medicare.gov. 

Appalachian Area Agency on Aging State Health Insurance Assistance Program (SHIP)

With Medicare’s annual open enrollment period, October 15 through December 7, quickly approaching, why not take advantage of your regional SHIP office.  Open enrollment is when you should review your current coverage and options for the 2019 calendar year.  Every year, there are changes to your current coverage and while your current plans should provide you with your Annual Notice of Change, the SHIP  Benefit Counselors at the Appalachian Area Agency on Aging can provide you with your best available options for the upcoming benefit year. 

The State Health Insurance Assistance Program (SHIP) provides free, in depth, unbiased, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIP is a grant-funded project of the federal U.S. Department of Health and Human Services (HHS), U.S. Administration for Community Living (ACL).

SHIP Counselors answer questions about Medicare and assist people in obtaining coverage through options that include the Original Medicare program, Medicare Advantage (Part C) Plans, Medicare Prescription Drug (Part D) Plans, and programs designed to help people with limited incomes pay for their health care, such as Medicaid, the Medicare Savings Program, and the Low Income Subsidy. SHIP Counselors also help people compare Medicare Supplemental (Medigap) insurance policies and explain how these and other supplemental insurance options — such as insurance plans for retirees — work with Medicare.

SHIP provides critical resources and expertise to federal partners.

• In South Carolina SHIP Counselors help Medicare beneficiaries make choices among a vast array of options that include an average of more than 21 prescription drug plans, 17 Medicare Advantage plans, as well as various Medigap supplemental insurance policies.

• SHIP Counselors also provide assistance with billing problems, appeal rights, and enrollment in low-income assistance programs. 

The Social Security Administration, CMS, 1-800-Medicare, Medicare Advantage plans, Medicare Part D prescription drug plans, local and state agencies and Congressional representatives and staff refer beneficiaries to SHIP. They include SHIPs in their websites, publications and correspondence to beneficiaries as the source of assistance when individuals need one-on-one assistance.

For more information or to volunteer please contact the Appalachian Area Agency on Aging at 1-800-434-4036 or 864-242-9733.