Originally published on homepage in 2019
Important Medicare updates for 2019 including costs, benefits, and requirements.
According to the Centers for Medicare and Medicaid Services (CMS), as of July 2017, more than 58 million Americans are enrolled in this social health insurance program. This includes people 65, disabled people under 65 and those with Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig’s disease) and end-stage renal disease (ESRD). With this huge consumer base comes equally huge costs. In 2016, Medicare accounted for 15 percent of the federal budget at about $588 billion. The Congressional Budget Office expects spending to top $590 billion in 2017 and jump to $1.2 trillion by 2027.
But with so many people relying on Medicare, this financial outlay is essential. As with any other government programs, Medicare is continually being examined and improved. This includes all four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage, private insurance plans) and Part D (prescription drug coverage). Changes made after the Affordable Care Act took effect in 2014 are some of the most significant changes to happen to the program, which has altered very little since its beginnings in 1965 under President Lyndon B. Johnson.
In 2016, updates to Medicare include new payment and pricing changes, including millions of enrollees being spared from enormous Part B premium increases. Other big changes involve coverage for specific procedures and end-of-life care and counseling and how patients receive medical care. These initiatives sought to redefine and improve the doctor-patient relationship, as well as Medicare enrollees’ overall experience.
Medicare Part B Increases Reduced for Millions
When it comes to Medicare, everything you need to know right now about specific plan costs centers on financial relief. The Medicare Board of Trustees (the Board), which is responsible for the program’s financial health, revealed that Part B premiums and deductibles for an estimated 52 million enrollees’ (about 30 percent of all Part B members) would increase again in 2017.
There were three reasons for this:
- Part B spending was higher than expected
- Sufficient funding had to be reserved for the Supplementary Medical Insurance (SMI) Trust Fund
- Lack of a cost-of-living adjustment (COLA) for Social Security benefits in 2017.
Under Social Security’s hold harmless rule, certain Medicare enrollees don’t have to pay a higher premium for Part B if there’s no cost-of-living adjustment from Social Security. This rule applies to anyone who has Social Security deduct Part B premiums from their payments as well as other select Medicare beneficiaries; about 70 percent of program subscribers fall into the hold harmless group. These “hold harmless” members paid $109 a month for coverage in 2017.
The remaining 30 percent of enrollees include those applying for Medicare Part B for the first time; those not currently collecting Social Security benefits; those with premiums paid by Medicaid (dual eligible); and those paying additional income-related premiums. In 2019, certain single and joint tax filers have a standard monthly Part B premium of $135.50. People who earn above a certain threshold pay more for Part B coverage. Here is the breakdown for 2019.
- $189.60 per month: Single filers earning $85,000–$107,000; Joint filers earning $170,000–$214,000
- $270.90 per month: Single filers earning $107,000–$133,500; Joint filers earning $214,000–$267,000
- $352.20 per month: Single filers earning $133,500–$160,00; Joint filers earning $267,000–$320,000
- $433.40 per month: Single filers earning $160,00–$500,000; Joint filers earning $320,000–750,000
- $460.50 per month: Single filers earning $500,000 and up; Joint filers earning $750,000 and up
In November 2015, Congress passed the Bipartisan Budget Act of 2015 (Public Law 114-74) . This spared enrollees from the much higher premium increases. So, in 2016, they only paid 16 percent more for Part B premiums – – $121.80, rather than 2015’s $104.90.This also includes a $3 repayment surcharge that will be added to monthly premiums over time to cover 2016’s reduced premiums. The premium increase from 2016 to 2017 was approximately 10 percent.
Even even if you’re in the group that was spared from paying higher monthly premiums for Part B coverage, you may still have to pay higher annual deductibles, which were raised in 2019 to $185.00 up from $183 in 2018. After your deductible is met, you’ll only be responsible for about 20 percent for Medicare-approved services (the coinsurance rate).
End Of Life Care – A Big Concern For Medicare Recipients In 2019
In 2017, dramatic changes were made to end-of-life options for Medicare, primarily in availability of newer options and how patients were counseled. “End-of-life” refers to all healthcare provided in the days or years before death, no matter whether it’s sudden or due to a long-term terminal illness. The Centers for Disease Control and Prevention (CDC) estimates that of the 2.5 million people dying each year in the U.S., about 75 percent are ages 65 and older.
This makes Medicare the largest healthcare insurer during the last year of life. About 25 percent of all Medicare healthcare spending goes to these enrollees, many of whom have various serious and complex conditions. Medicare covers a host of services – both curative (for curing) and palliative (relieving pain, discomfort) – that can be utilized right up until a member’s death. Among these are care in hospitals and several other settings, home healthcare, physician services, diagnostic tests and prescription drug coverage.
Beneficiaries with a terminal illness also qualify for benefits that wouldn’t normally be covered under original Medicare, such as bereavement and hospice services. End-of-life services are controversial, due to their costs and the difficult discussions and issues surrounding them. Originally, the Affordable Care Act (ACA) authorized voluntary, personalized counseling. But due to public outcry, this provision was quickly removed from the healthcare law. However, Medicare has reinstated this counseling.
Hospice benefits also played a part in Medicare as it introduced the new Care Choices model. Previously, enrollees opting for hospice benefits had to give up most curative care. But the new model allows those with terminal illnesses to receive hospice services without giving up treatment. On Jan. 1, 2016, 70 hospices began offering these new services; another 70 will join in 2018. Medicare also began covering advance care planning as a separate and billable service in 2016. Advance planning involves discussions between healthcare providers and patients regarding end-of-life care and patient preferences.
Changes to ACO selection
Medicare focused on how medical care was delivered to patients in 2018-2019. Key areas included teamwork among clinicians, particularly that of primary care doctors; the timeliness of preventive services; and patients transitions between hospital and home.
Medicare estimated that nearly 8 million beneficiaries (20 percent of original Medicare) were currently enrolled in Accountable Care Organizations (ACOs). ACOs are networks of doctors and hospitals with the goal of delivering better quality care at lower costs “Five years ago, there was minimal incentive to coordinate care,” said Patrick Conway, Medicare’s chief medical officer. “Physicians wanted to do well for their patients, but the financial incentives were completely aligned with volume.” With ACOs, networks get part of their reimbursement for meeting quality or cost targets; their long-term effectiveness is still being determined. But Medicare kicked off a major expansion in 2016. Enrollees could select their own ACO for the first time, and they can opt out if they preferred.
Joint Replacements’ Quality and Costs Examined
Another change to Medicare in recent years was an experiment involving two types of joint replacements: hip and knee replacements. These are Medicare’s most common surgeries. In 2014, more than 400,000 beneficiaries received hip or knee replacements. The CMS estimated that these procedures cost more than $7 billion for the hospitalizations alone. And for Medicare, average costs can vary widely within different geographic areas, ranging from $16,500 to $33,000. In addition, these surgeries require long recovery and rehabilitation periods. Their actual quality, in and out of the hospital, can also vary depending on the area and facility.
As such, it’s understandable that efforts have been made to improve the procedures’ quality while keeping costs down. In April 2016, hospitals in 67 metro areas and communities will take part in an experiment designed to manage these procedures’ total costs. The 90-day experiment will begin with the patient’s initial doctor’s visit, and encompassed surgery and rehabilitation.