How Will Medicare Part C and Part D Change in 2019?

Victoria Burke by Victoria Burke | Licensed since 2011
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This article was updated on: 10/06/2018

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Did you know Medicare is making some changes for 2019? Goals of these Medicare changes include better serving beneficiaries and reducing the administrative burden on Medicare health and prescription drug plans. The Centers for Medicare & Medicaid Services (CMS) estimates the Medicare Advantage (Medicare Part C) and Medicare Prescription Drug coverage (Medicare Part D) changes will save Medicare around $295 million every year. Most of the changes will be effective in 2019.

Medicare changes: how did Medicare Advantage change in 2019?

Here’s a quick summary of the Medicare changes for Part C in 2019. The Centers for Medicare & Medicaid Services (CMS):

  • Is lifting certain restrictions on the types of Medicare Advantage plans that insurance companies can offer. Under these restrictions, a company couldn’t offer multiple plans within the same county if the plans appeared too similar to one another.
  • Streamlines the review process for marketing materials to beneficiaries
  • No longer requires insurance companies to submit certain accounting information along with their bids to offer Medicare Advantage plans
  • Adds a new, limited “Open Enrollment Period” for Medicare Advantage plans
  • No longer requires certain providers to meet enrollment requirements
  • Lets Medicare Advantage insurance companies send beneficiaries certain documents electronically, instead of by mail. For example, plans must send you an Evidence of Coverage document every year. Now the plan can email it to you instead of mailing it.
  • Lets Medicare Advantage plans renew coverage for beneficiaries automatically and seamlessly year by year
  • Changes the cost-sharing requirements for Medicare Advantage plans
  • Lets Medicare Advantage plans charge different annual deductibles for beneficiaries that meet certain medical criteria
  • No longer mandates that Medicare Advantage plans complete Quality Improvement Project (QIP) requirements. CMS found that Quality Improvement (QI) requirements already include the QIP activities.
  • Reduces certain paperwork requirements so that plans won’t have to report as much “medical loss ratio” data as it used to. Please note this may still be in the proposal stage and not a final rule.

Medicare changes: how did Medicare Part D change in 2019?

Some of the Medicare changes listed above apply to Medicare Prescription Drug Plans as well. Here’s a quick summary of the other changes to Medicare Part D (prescription drug coverage) requirements. The Centers for Medicare & Medicaid Services (CMS):

  • Lets Medicare Prescription Drug Plans (PDPs) restrict access to opioids (and certain other prescription drugs) for Medicare beneficiaries who are at risk of addiction. Plans won’t restrict access to pain medications such as opioids patients, such as some cancer and hospice patients.
  • Lowers costs for beneficiaries by changing certain requirements about cost sharing for generic drugs.
  • Reduces waste by changing a requirement for long-term care settings. This rule reduces the quantity of prescription drugs that PDPs need to supply at one time. For example, instead of providing a 90-day supply all at once, it might only need to provide a 30-day supply at a time.
  • Increases flexibility of formulary changes. For example, a PDP plan can substitute a generic drug for a brand-name drug in some cases, as long as the plan follows certain rules.

Please note that the lists above don’t include all the Medicare changes CMS is making in 2019 and later.

If you have questions about Medicare Advantage or Medicare Prescription Drug Plans, you can ask me. Follow the links below to set up a phone call with me or ask me to email you customized information. Click the Find Plans or Compare Plans buttons on this page anytime to see a list of plans in your area.

Benefits may change on January 1 of each year.

A plan’s formulary may change at any time. You will receive notice from your plan when necessary

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