Changes are coming to Medicare, but that’s nothing new. Slight changes are made to Medicare every year to make it work better for enrollees and this year is no different. Have you kept up with all the latest Medicare changes? If not, don’t worry—we’ll fill you in.
The first thing to understand is that Original Medicare is comprised of two basic building blocks: Part A and Part B. Part A, which mainly covers hospital care, is generally available at no monthly premium. As long as you or your spouse have paid into the Medicare program through your taxes for at least 10 years, you won’t have to pay that Part A premium. Part B, which mainly covers doctor visits and tests, has a monthly premium based on income. Most Medicare beneficiaries pay the standard Part B premium. A small percentage of Part B enrollees have a higher income that requires them to pay a higher Part B premium.
The Medicare “Donut Hole”
The coverage gap, often referred to as the “donut hole,” is when your total drug spending, combined between you and your insurance company, reaches a certain amount. If you reach that amount, you’re in the donut hole and you’re responsible for a higher share of the cost of your medications. The donut hole has a limit to the amount you’ll have to pay. After you reach this limit, you leave the donut hole and will have catastrophic coverage where you pay a very small share for your drugs.
The good news is that the coverage gap is shrinking, and sooner than expected. Since 2020, Medicare beneficiaries who reach the donut hole will only pay 25% of the cost of their brand name and generic prescription drugs.
Medicare Advantage on the Rise
One of the biggest changes to Medicare over the past 10 years has been the increase in people choosing Medicare Advantage plans. In 2021, 43% of Medicare beneficiaries throughout the U.S. selected a Medicare Advantage plan. In 2019, 41% of the people in Michigan who are eligible for Medicare chose a Medicare Advantage plan.
One of the reasons for this growth is that Original Medicare doesn’t cover all medical expenses and some individuals want or need more coverage. Another reason is because people have come to expect the attention they get from a private insurance company. Medicare Advantage plans can include:
- Care management—which connects members with their health plan’s experts for complex medical needs
- Prescription drug coverage
- Reminders for preventive visits and prescription refills
- Resources for healthy lifestyles, often right in the local community
- Vision, dental and hearing coverage options
- Gym memberships or other ways to get or stay active and healthy
The make-up of a Medicare Advantage plan
Medicare Advantage plans take the place of Original Medicare—or Part A and Part B. They’re offered by private insurance companies and cover everything Original Medicare does—plus they often offer additional benefits like gym memberships, prescription coverage and health and wellness programs.
When you select a Medicare Advantage plan, you’ll still need to pay your Part A and Part B premiums (remember, the Part A premium is no cost for most beneficiaries). But what you don’t need to think about with Medicare Advantage plans are Part A and B deductibles. Instead you’ll be responsible for your Medicare Advantage plan’s medical deductible, as well as a prescription deductible, if one is applicable.
Plan Ratings can Change Every Year
How well a health plan takes care of its members should be an important part of your Medicare decision-making process. Fortunately, the Centers for Medicare and Medicaid Services (CMS) offers an easy way to gauge a plan’s quality: star ratings.
Star ratings measure things like how well a plan helps their members stay healthy and manage chronic conditions. It takes into account member experiences with the plan, from overall satisfaction to customer service. And for Medicare Advantage plans that offer prescription coverage, that performance is also included in the star rating. The highest possible rating is five stars. For plan year 2022, Priority Health’s HMO-POS plans earned 4.5 Stars, while our PPO plans earned 4 Stars
Want to learn more about Medicare? Visit Priority Health’s website, or call your insurance company’s customer service department. Priority Health members can use the phone number on the back of their member ID card.