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How Do the New CMS Rules Affect 2019 Medicare Plans?

The Centers for Medicare and Medicaid Services (CMS), which runs the Medicare program, has issued new rules for Medicare. These changes affect both Medicare Advantage plans (Part C) and Medicare supplement plans (which help pay for what Original Medicare Parts A and B don’t cover.

What’s Changing in Medicare Advantage Plans?

In April 2018, in response to increasing recognition among health care researchers that “the social determinants of health” had an exceptionally large impact on health status, CMS allowed Medicare Advantage plans to offer additional benefits not previously provided.

Among these are:

  • In-home non-skilled assistance for tasks such as eating, dressing, and bathing.
  • Meals delivered to the home.
  • Wheelchair ramps, bed rails, grab bars in bathrooms, shower chairs, and a wide range of other options.

The one constraint is that the new benefits cannot include increased income or living situations that are not related to health conditions. Medicare Advantage plans will begin to explore what they can offer and what CMS might approve over the next few years, and the basket of services actually offered is likely to be changing for a while. Transportation assistance was already being offered by some plans even before the CMS rules changed.

Test-drive Your Medicare Advantage Plan

Before 2019, you were limited in your ability to switch Medicare Advantage plans outside of open season. Beginning January 1, 2019, you can test-drive your Medicare Advantage plan and, if you are not satisfied after three months, you can switch back to Original Medicare (Part A, B, and D), or to another Medicare Advantage Plan.

More Telemedicine

Telemedicine involves contact with a medical provider through electronic means, such as a computer or smartphone. For now, Medicare payments for this service will be limited to treatment for end-stage renal disease or recovering from a stroke. Telemedicine can save time and effort for both the patient and the provider.

Limits Removed for Several Types of Therapy

The limits on physical therapy, speech therapy, and occupational therapy that previously existed have been removed. However, patients must still demonstrate progress to keep receiving services. If the therapies produce no improvement, they will be terminated after a reasonable time.

Medicare Supplement Plans: Plan F Eliminated for New Enrollees

Starring in 2020, Medicare Supplement Plan F, which was considered the “Cadillac” of Medicare Supplement plans, will be eliminated for those not currently enrolled in it. This was done to control costs; CMS felt, among other reasons, that having so much coverage for out-of-pocket expenses eliminated that “skin in the game” that would lead beneficiaries to consider cost when choosing providers and treatments. Plan G, which is expected to become the most popular plan, differs only in that beneficiaries have to pay the $183 part B deductible. Switching from Plan F to Plan G will reduce your premiums about $30 per month, on average.

So, What Do I Need to Do Now?

If you could gain from the new benefits that Medicare Advantage plans can now offer, you need to find out which plans offer the ones you need and consider switching to that plan or moving from Original Medicare to an Advantage Plan. Remember, the benefits offered are likely to be changing for a while.

If you were planning to enroll in Plan F for a Medicare supplement, do so before 2020. A professional health insurance agent can guide you through these choices and avoid some of the complexities for you. Visit or call them at (844) 374-1950.