Wednesday, December 12, 2018


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Time is running out to give your Medicare coverage a checkup and make changes for 2019.

“You could end up with surprise bills because your providers are no longer participating in your plan or because your medication costs went up,” said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans.

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Pascal Broze | Getty Images

With the specifics of plans changing from year-to-year and new options available to many recipients, experts recommend making sure your current coverage will still make sense for 2019.

Through Friday, Medicare recipients can:

· Switch to an Advantage Plan (Part C) from original Medicare (Part A hospital coverage and Part B outpatient coverage);

· Switch to original Medicare from an Advantage Plan;

· Move from one Advantage Plan to another;

· Move from one prescription drug plan (Part D) to another, or purchase one if you did not when first eligible (although you could face a penalty for late enrollment).

New for 2019: If you pick an Advantage Plan during fall enrollment and realize afterward that it’s not a good fit, you can switch to another one or back to original Medicare and a standalone Part D prescription plan between Jan. 1 and March 31.

However, in that early year window, you cannot go from one standalone drug plan to another, or go from original Medicare to an Advantage Plan.

Also, you can only do one switch during that window. In the current enrollment period, you can change your mind multiple times.

The number of plans you can pick from largely depends on where you live.

The more rural the area, the more likely you are to have fewer choices for an Advantage Plan. In fact, 115 counties dotting the country have none available to them for 2019, according to the Kaiser Family Foundation. That’s down from 149 counties without one in 2018.

However, the average person on Medicare will be able to choose from 24 plans. For prescription drug coverage, the average beneficiary can choose from 27 standalone plans or 21 Advantage plans that include the coverage for 2019.

This means that even if you haven’t wanted a different option in the past, the situation could be different for 2019.

While the insurers are federally regulated, the specifics can vary greatly from plan to plan, county to county and year to year. Changes can affect things such as your premiums, deductibles, co-pays, covered services and participating doctors and other providers.

Also, look closely at your prescription drug coverage, whether through an Advantage Plan or a standalone Part D plan. Even if your premium goes down, the price of certain drugs could be higher for you.

Monthly premiums for Part D prescription plans will be lower on average for 2019 coverage, according to the Centers for Medicare and Medicaid Services, falling to $32.50 in 2019 from $33.59 this year.

Nevertheless, Gavino has a client whose Part D costs were $305 for 2018, including his premiums and co-pays. For 2019, if the client were to remain with his plan — with no change in the medicine he takes — his out-of-pocket cost would jump to $2,033.

You can check medication prices through the government’s Medicare Plan finder.

To make sure your doctor, pharmacy or other provider is still in network, you have to check with the insurance company that offers the plan. You can either visit the provider’s website or call. And if you work with a Medicare agent, that person also should be prepared to help you.

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