As we head into the holiday season, I want to let you know how much your Medicare will cost in 2019.
Most people with Medicare will pay the standard monthly premium for Medicare Part B, which will be $135.50 next year, an increase of $1.50 over 2018.
Part B covers physician services, outpatient hospital services, some home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
Your Part B premium is based on your income. People whose tax returns show income equal to or higher than $85,000 pay higher premiums. These income-adjusted premiums apply to about 5 percent of all Medicare beneficiaries.
The premiums for higher-income beneficiaries for 2019 can be found here: https://www.cms.gov/newsroom/fact-sheets/2019-medicare-parts-b-premiums-and-deductibles.
The annual deductible for Part B is $185 in 2019, an increase of $2 from 2018.
Medicare Part A covers inpatient hospital, skilled nursing and some home health services. The vast majority of Medicare beneficiaries do not have to pay Part A premiums since they or their spouses paid Medicare payroll taxes for at least 40 quarters (10 years).
The Part A inpatient hospital deductible that beneficiaries pay when admitted to the hospital will be $1,364 in 2019, a $24 increase over 2018.
There are two ways to get your Medicare benefits: Original Medicare and Medicare Advantage.
With Original Medicare, you can choose any doctor, hospital or other healthcare provider you want, as long as they accept Medicare. When you receive medical services or goods, Medicare pays the provider directly. About 70 percent of all Medicare beneficiaries have Original Medicare.
The other way to get your benefits is Medicare Advantage, which is a form of managed care, like an HMO or PPO. Medicare Advantage is provided by private insurance companies that have been approved by Medicare. If you are in Medicare Advantage, you generally must go to doctors and other providers in the company’s network.
If you go outside the network, you may have to pay more.
On the other hand, Medicare Advantage plans may offer some services — such as dental, hearing, vision and prescription drug coverage — that Original Medicare does not cover.
Most people with Original Medicare pay a monthly Part B premium. If you are in Medicare Advantage, you may have to pay an additional monthly premium to the private insurer that covers you.
With Original Medicare, you or your supplemental insurance must pay deductibles, co-pays and co-insurance.
To cover these “gaps” in Medicare, some people buy supplemental insurance called Medigap. If you have a Medigap policy, Medicare pays its share of covered costs and then your Medigap policy pays its share.
Original Medicare does not cover prescription drugs. If you want drug coverage, you can buy a separate Medicare Part D plan. Such plans are sold through private insurers approved by Medicare. You have to pay an additional monthly premium for Part D.
On average, Medicare Advantage premiums in 2019 are projected to decrease by 6 percent to $28, from an average of $29.81 in 2018.
Some plans are providing new types of benefits in 2019, including:
• Adult day care services, in-home support services, caregiver support services, home-based palliative care and therapeutic massage; and
• Reduced cost sharing and additional benefits for enrollees with certain conditions, such as diabetes and congestive heart failure.
The average monthly basic premium for Part D prescription drug plans is expected to fall from $33.59 this year to $32.50 next year. This is the second year in a row that average Part D premiums have declined.
And while we’re talking about costs, don’t forget that Medicare Open Enrollment season is here and lasts until Dec. 7, 2018.
This is the time each year when you can shop around for a new Medicare Advantage health plan or Part D drug plan that better meets your health needs and pocketbook.
To help you, we’ve developed an online calculator that can give you an idea of how much you’ll pay out-of-pocket for a Medicare Advantage plan versus Original Medicare plus a Part D plan and a Medigap plan.
You can access the calculator at https://www.medicare.gov/oopc/.
Greg Dill is Medicare’s regional administrator for Hawai‘i, California, Nevada, Arizona and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).