The annual Medicare open enrollment period kicks off today, and the news is generally good for nearly 4.4 million Floridians who rely on the program. Premiums are expected to stay roughly the same in 2019, and many plans are offering expanded perks and benefits.
Officials at the Centers for Medicare & Medicaid Services, known as CMS, have approved a wide range of new features for people insured through Medicare Advantage, the privately run alternative to the government program known as Original Medicare. Those extras include more "wellness" perks like expanded coverage for rides to medical appointments or even the grocery store, and in-home visits to ward off isolation and loneliness for recovering patients.
"Medicare Advantage beneficiaries will have more supplemental benefits, making it easier for them to lead healthier, more independent lives," CMS Administrator Seema Verma, said in a statement.
Medicare Advantage plans, which continue to grow in popularity, traditionally have included additional services such as vision, dental care and sometimes gym memberships. But insurers have been venturing into even more areas, eager to capture their share of growing enrollment and mindful of rules aimed at keeping patients away from expensive hospital care.
Humana, for example, has been piloting wellness-type programs focused on food insecurity and isolation among Florida’s seniors in recent years, said Deb Galloway, president of Medicare for the company.
She said it’s been a slow process to get CMS to approve many of the new supplemental benefits, but consumers will start seeing them roll out more widely this year.
"We’ve been paying close attention to the social determinants of health recently," Galloway said. "As you age, these components do affect your health. This year, CMS has been more flexible about approving these types of benefits."
Humana found that patients are more likely to end up in the hospital if they are depressed or lonely. They are also less likely to take their medications as directed if they struggle to get to a grocery store where they can purchase healthy foods, Galloway said.
"Especially for people who are managing chronic disease, there is this ripple effect," she said.
So some Advantage plans available to Floridians will include regular wellness check-ups, where an aide will visit a home-bound patient regularly and offer Meals on Wheels programs after hospital stays.
Other insurers are offering Advantage plans that cover the cost of air conditioners for patients with asthma or even installation of grab bars in home bathrooms. Some plans pay for over-the-counter personal care items like toothbrushes and toothpaste, pill boxes, and cough and cold medicines.
In addition, most Medicare Advantage plans are beefing up their telemedicine offerings, which include virtual doctor appointments consumers can attend from home.
"We’re seeing a much greater demand for services like this," Galloway said. "Especially from a behavioral health standpoint. We’ve identified a shortage of providers in Hillsborough County, and so virtual visits play an important role."
Also new this year: Beneficiaries who enroll in Medicare Part D, which covers prescription drugs, no longer will be exposed to the long-standing coverage gap, or "donut hole," when filling brand-name medications. The change is being instituted for the first time this year after Congress moved to phase out the gap by requiring drug manufacturers to offer discounts on the price of brand-name drugs.
The donut hole originally was created to encourage seniors to play a role in keeping drug costs down by encouraging them to ask for generic drugs. But the strategy has proven to be a hardship for many who rely on brand-name options.
Consumers reach the donut hole when the total cost of their drugs for the year, including deductibles and copays, reaches a certain amount. After that, they pay all their drug expenses until they reach a larger amount that brings them to the end of the "hole." From there, they are entitled to "catastrophic" coverage with much lower costs.
Under the new rules starting in 2019, consumers who reach the donut hole will have to pay only 25 percent of brand-name prescription drug costs compared to 35 percent this year.
The donut hole for generic drugs is expected to be phased out in 2020.
Another change this year is that consumers can take advantage of a second enrollment period, which has been reinstated after several years without it. From Jan. 1 to March 31, those who are unhappy with their coverage can switch to a different Medicare Advantage plan or return to the so-called "Part A" and "Part B" coverage offered under Original Medicare.
"This change is better for members," said Luisa Charbonneau, vice president of Medicare with Florida Blue, the state’s largest insurer. "They can make changes now if they’re not happy with their coverage, which wasn’t as easy before."
The Centers for Medicare & Medicaid Services is also issuing new Medicare cards to enrollees nationwide. Over the last year, Floridians have been getting the new cards, which have been redesigned to remove an individual’s Social Security number as a fraud deterrent. Those who haven’t received one yet will likely get one by the end of the year or before the spring.
"We’ve been trying to get the word out as much as possible about the new cards," Charbonneau said. "And also that CMS has made changes to its Plan Finder online, which should make it easier for consumers to compare plans and benefits."
In addition, Medicare beneficiaries won’t have to pay the full cost of some outpatient therapies anymore, thanks to a cap on this kind coverage that was repealed by Congress. Outpatient care of physical, speech or occupational therapy should have cheaper out-of-pocket costs in 2019.
Last year, Floridians were among the millions affected nationwide by rising premiums for Part B plans, which cover outpatient care, doctor bills, physical therapy and more routine health services. Part B is optional to enroll in and costs most people a monthly premium, which was on average around $134 the last two years, depending on the enrollee’s income.
Participants paid around $109 a month in 2017 if they chose to have the monthly fee deducted from their Social Security checks. However, those prices were raised last year to account for cost-of-living adjustments in Social Security pay outs. This year, insurers say that Part B premiums won’t change much from last year, if at all.
Going into the enrollment period, it appears that premiums for Original Medicare and most Advantage plans will remain close to the same — with some going up and others going down, and some expanding coverage. However, any change could mean some doctors may no longer be part of the network, or certain prescription medications may become more expensive or not be covered at all.
Enrollees are urged to research the options available for 2019 before choosing the same plan from years prior.
Contact Justine Griffin at [email protected] or (727) 893-8467. Follow @SunBizGriffin.