2019 Part D Changes
Here are the Part D changes for 2019 that you need to know!
If your plan has a deductible it may go up. The initial Part D deductible will increase by $10.00 to $415 for 2019.
What does this mean to you?
If your Medicare Part D Rx drug plan has a deductible, you may pay more out-of-pocket in 2019 before your insurance plan begins covering your medications. For example, if you are taking Xarelto which costs about $500 and your plan has a $47 copay then the first refill will cost $462 ($415+$47) and then will be $47 each month after that until you reach the Initial Coverage Limit and enter the “Donut Hole.”
Not all Part D Prescription Drug Plans have a deductible and many plans exclude lower-cost generic drugs from the deductible, giving you coverage for these Tier 1 or Tier 2 drugs before you need to pay your deductible.
Beginning January 1, 2019 your Initial Coverage Limit (ICL) will increase from $3,750 to $3,820.
This means that you will be able to buy slightly more medications before reaching the 2019 Donut Hole or Coverage Gap. A good rule of thumb is that if the full retail cost of your medications is less than $320 per month, you will not enter the Donut Hole before the end of the year.
Good news! The Donut Hole discount will increase 10% in 2019!
The discount you get on brand-name drugs will increase from 65% to 75%. So, if you are using a brand-name medication such as Advair which has a retail cost of around $400, you will pay $100 for your medication or if you take Lantus which has around a $300 price tag, you will pay $75 while in the Donut Hole.
What is the end result?
In 2019 you will have to spend only about $25 more to get out of the Donut Hole than you did in 2018. The Out of Pocket Threshold (or TrOOP) has increased from $5,000 to $5,100 which will trigger entry into the Catastrophic Coverage Phase where you will remain for the rest of the year.
While in the Catastrophic Coverage Phase you will pay either 5% of the total retail cost of the drug OR $8.50 for brand-names and $3.40 for generics, whichever is higher.
If you need a more in-depth explanation of how Part D works or want to review what plans have the lowest costs and will help you avoid the Donut Hole, give me a call. My number is 207-370-0143. I will be happy to help you.
Be sure to read your Annual Notice of Change Letter (ANOC) that should arrive in the mail each year at the beginning of October to see how your plan is increasing – this may help you determine how much you need to budget in 2019 to cover the costs of coverage. [READ MORE …]
If you would like to ask a question or schedule a meeting at your home or a nearby meeting place, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.
The best part about working with me is that it does not cost you anything to talk with me to discuss your options and review the plans that are available. My services are free to you. I am paid by the insurance companies in the form of a commission when you enroll in a plan. You pay nothing for my help!
And you will not pay any more than anyone else and you are under no obligation whatsoever to change your plan if you talk with me.
“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”
You can quickly become overwhelmed with all the choices and information – and that usually results in choosing the wrong plan!
The plans offering gym reimbursements are the most popular because they allow you to join the local gym that is nearby your home.
If you permanently move somewhere that your current Medicare plan does not cover (outside the service area), you should call your insurance company immediately and begin looking for a new plan. The phone number for customer service is located on the back of your insurance card.
The same rules for the Medicare Advantage plans above apply to your Part D plan. If you don’t enroll in a new Medicare Prescription Drug Plan during your enrollment window, you might find yourself without Medicare prescription drug coverage, and you could face a Medicare Part D late-enrollment penalty if you pick up this coverage later on.
Make sure you notify Social Security of your change of address. The Social Security Administration handles Medicare enrollment. You can change your address by calling the Social Security Administration at 1-800-772-1213 (TTY users 1-800-325-0778) and speak to one of their representatives from Monday through Friday, from 7AM to 7PM. You can also visit the Social Security office nearest you and fill out a change of address form or visit them online at 
Step 3 – Cancel over the phone!
Step 4 – Protect yourself!
If you call after the 15th of the month before you start your Medicare insurance then your coverage will end on the last day of the next following month. This is why is so important to begin this process 3 months before your 65th birthday!
Perhaps your Medicare Advantage plan has some costs you were not aware of when you signed up or your plan changed this year. Some of these changes may include; higher d
Since Medicare Advantage plans are completely administered through a private insurance company, the rules and guidelines can vary between plans and from year to year, which can lead to restrictions like these:
What do you have to do?
If you live in Maine or New Hampshire and would like more answers or if you’re looking for help choosing a Medicare plan or just have some questions, I would be more than happy to help you.
It will not, however, pay for any follow-up dental care after the underlying health condition has been treated. So, if Medicare paid for a tooth to be removed as part of surgery to repair a facial injury, do not expect Medicare to pay for any other dental care you may need later because you had the tooth removed, and Medicare will not pay for dental implants or dentures to replace the extracted tooth.
Some Medicare Advantage Plans Include Dental Coverage
