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Medicare Heads Up: October 18, 2019

A round-up of the state and national Medicare news that matters to consumers

A Medicare Advantage carrier's voucher for the purchase of an Apple watch is one result of CMS changes that allow for greater flexibility in the supplemental benefits that focus on prevention and holistic care.

Welcome to the first installment of Medicare Heads Up – a regular feature intended to deliver state and national Medicare-related headlines that will keep consumers abreast of developments that affect their coverage and costs. This week:

Medicare open enrollment has started and runs through December 7

Open enrollment for Medicare Advantage and Medicare Part D coverage started this week and continues through December 7. During this open enrollment period, beneficiaries can make a variety of changes to their Medicare Advantage and Medicare Part D coverage, including switching from one Medicare Advantage plan to another.

New Medicare enrollees will lose two Medigap options after this year

Medigap Plans C and F will no longer be available for newly qualified Medicare enrollees after 2019. The change comes due to the 2015 federal law which axes coverage for Part B deductibles after 2019. Future 65-year olds will not have access to the two plans which cover the deductible – which is currently $185. Plan F is the most popular as it offers wide coverage but also comes with a high premium. It will be replaced with Plan G, which offers the same coverage as F – only with no Part B deductible coverage. Medigap plans can only be used with original Medicare, not Medicare advantage. In most states, there are up to 11 standardized Medigap plans available (including a high-deductible version of Plan F), but multiple insurers can offer each plan.

Out-of-pocket costs for Part D prescription coverage increase for 2020

In 2020, the maximum Part D deductible will increase to $435 (up from $415 in 2019). And Part D enrollees will enter the coverage gap after their total drug costs reach $4,020 (up from $3,820 in 2019). Once in the coverage gap, they have a 75% discount on the cost of their brand-name and generic drugs (so enrollees on standardized plans will pay the same 25% of the cost that they paid before reaching the coverage gap; from this perspective, the coverage gap has closed as of 2020). Enrollees will reach catastrophic coverage after paying $6,350 out of pocket on drugs (up from $5,100 in 2019).

Trump executive order on Medicare could raise prices and limit choices for consumers

A recent executive order to remove “unnecessary barriers” to patients and providers negotiating prices outside of Medicare is being viewed warily as a step towards private Medicare Advantage plans and a strategic disruption of traditional Medicare costs and coverage.

Medicare’s Plan Finder tool gets an upgrade

CMS announced that the Medicare Plan Finder tool has been upgraded for the first time in a decade. Both the old and new plan finder tool were available through the end of September 2019. Since then, only the new tool is available. The new tool includes a wide range of improvements and automation, and keeps up with the increasing tech-savviness of new Medicare enrollees. But some consumer advocates and enrollment assisters also have concerns about privacy and ease of use with the new tool.

Medicare beneficiaries are targets of new Telemedicine scams

Federal authorities are warning seniors about phone calls from scammers who – under the guise of telemedicine providers – are bilking taxpayers and Medicare out of billions of dollars. The scams involve telemarketing companies contacting beneficiaries, then getting prescriptions from providers (typically for unnecessary back, knee or wrist braces), and then selling those prescriptions to medical supply companies who then bill Medicare. Several large rings have already been busted, but if you get a call – and then a pile of unwanted medical equipment shows up at your home – contact your local FBI office. Chances are your Medicare policy is being gouged by criminals who are manipulating telemedicine, a new and vulnerable technology designed to help those who live in remote areas but instead is turning into a vehicle for theft.

Apple watch to be covered by Medicare Advantage start-up Devoted Health

Seniors with a penchant for technology will be in luck with Devoted Health’s offering of up to $150 towards an Apple watch for members. The Apple watch is a result of the CMS changes to Medicare Advantage plans which are allowing for greater flexibility in the supplemental benefits offered, with a focus on prevention and holistic care. Devoted Health, which offers Medicare Advantage plans in Florida, is offering members a $150 voucher to apply towards an Apple watch, and joins several other insurers who have partnered with Apple, and other device manufacturers like Fitbit. Apple has made a concerted effort to infiltrate the lucrative senior marketplace with its wearable watch device offering fall detection, heart monitoring, and emergency service contact alert features.

10 percent of Medicare enrollees are food insecure according to new report

A recent report by JAMA found that 10 percent of Medicare beneficiaries are food insecure, which means they have been unable to get adequate, healthy food due to financial strain. Food insecurity has become one of many social determinants of health being addressed by Medicare Advantage plans, which are now allowed by loosened federal regulations to offer supplemental services like rides to the grocery store or food delivery.

20 private Medicare plans have earned a 5-star rating for 2020, up from 14 in 2019

Medicare uses a star rating system for Medicare Advantage and Medicare Part D plans. For 2020, there are 20 plans that earned five stars, up from 14 in 2019. They’re available to beneficiaries in certain areas of California, Washington, Colorado, Georgia, Hawaii, Virginia, Maryland, the District of Columbia, Illinois, Wisconsin, Minnesota, Iowa, and Nebraska. If a five-star plan is available in your area, you can switch to it (up to one switch per year) outside of the annual enrollment period.

Jesse Migneault is a journalist and editor who has written about business, government and healthcare – including public and private-payer health insurance. His articles have appeared in HealthPayerIntelligence, the Hartford Courant, Portsmouth Herald,, Foster’s Daily Democrat, and York County Coast Star.

In addition, his work has been cited by health industry stakeholders such as the Eugene S. Farley Health Policy Center, Association of Healthcare Journalists, American Academy of Actuaries, Kaiser Permanente, blueEHR, San Diego Law Review, Medicare Agent News,, and Concierge Medicine among others.

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Dave Streifford
2 years ago

Re switching between Original Medicare [OM] and Medicare Advantage [MA] plans, it appears that there is a major change re Medigap plans [supplements]. The following is a verbatim quote from your text on this matter:
“(Note that for people who were previously enrolled in Original Medicare, switched to Medicare Advantage, and want to switch back within the first year, Medigap coverage is only guaranteed-issue if the person had been enrolled in a Medigap plan and discontinued it in order to enroll in Medicare Advantage.)”

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My concern relates to medical underwriting. Take this case: a person enrolled in Original Medicare and bought a Medigap plan [but assume it was Plan G, a plan still offered]. Now, during open enrollment, this person wants to switch to MA. So far, so good. But then in February 2020 this individual decides to switch back to OM and buy a different Medigap plan from a different insurance company. QUESTION: does medical underwriting now apply under the new law, OR is it a guaranteed-issue plan as is stated above?

Many thanks for your reply.

1 year ago

Hi Dave,
This isn’t a new rule. The trial right period allows people to try Medicare Advantage for up to a year without giving up their guaranteed-issue access to Medigap. So it’s available to people who enroll in Medicare Advantage as soon as they become eligible for Medicare, and then decide they want to switch to Original Medicare within the first year—they can enroll in any Medigap plan in their area at that point, guaranteed issue. It’s also available to a person who is already enrolled in Original Medicare plus a Medigap plan. If they want to try an Advantage plan but then decide within a year that they’d prefer to switch back to Original Medicare, they have the right to re-enroll in the same Medigap plan they had before they switched to the Advantage plan (or, if that’s no longer available, they can enroll in any available Medigap Plan A, B, C, F, K, or L). But the trial right period doesn’t apply to someone who switched away from Original Medicare to a Medicare Advantage plan but didn’t have a Medigap plan before switching. And it doesn’t apply if the person has switched back and forth between Medicare Advantage and Original Medicare in the past.

So in the example scenario you described, that person will be able to switch back to Original Medicare in February and re-enroll in the same Plan G that they had before. If that plan is no longer for sale, they can pick any Plan A, B, C, F, K, or L, from any of the companies that offer those plans in their area, and the coverage will be guaranteed-issue. But if their original Plan G is still for sale and they’d rather select a different plan from a different company, the insurer will be able to use medical underwriting (assuming they’re not in one of the few states where Medigap plans aren’t subject to medical underwriting).

Would love your thoughts, please comment.x