What changes are occurring to Medicare for next year?

There are changes to Medicare premiums coming in 2018.

In the face of low Social Security Cost-of-Living Adjustments (COLA) and because of the Medicare hold-harmless provision, premium increases cannot exceed the 2 percent increase in Social Security benefits. If you are within the hold-harmless group, you were paying $109 in 2017 and may pay $134 in 2018, as long as that $25 increase is not more than the amount you received from the 2 percent Social Security increase. Some may see a slightly less amount ($130) if the 2 percent Social Security benefit increase is less than $25.00.

In general, the Medicare Part B premium will remain the same for those who paid $134 per month in 2017. As above, if you were in the “hold harmless” group and paid $109 in 2017, your premium could be increasing to $134.

The annual Part B deductible did not increase in 2018 and will remain at $183.

Part B Premium and Deductible Amounts for 2017 – 2018 2017 2018

Part B Premium for those held harmless $109 $130 – $134

Part B Premium for those not held harmless 134 134

Part B Deductible 183 183

For those that pay for their Medicare Part A, premiums will increase by $9 to $422. Other changes to Medicare Part A are illustrated in the table below:

Part A Deductible and Coinsurance Amounts for 2017-2018 by Type of Cost Sharing 2017 2018

Inpatient hospital deductible $1,316 $1,340

Daily coinsurance for 61st-90th Day 329 335

Daily coinsurance for lifetime reserve days 658 670

Skilled Nursing Facility coinsurance 164.50 167.50

Some changes were made to Medicare Part D prescription drug plans available beginning January 1, 2018. The Part D base beneficiary premium has increased slightly to $35.02. The Part D deductible for 2018 is $405 (up from 2017’s $400). North Dakota residents have access to 23 different plans, offered by 11 companies, with premiums ranging from $20.70 to $100.60 per month.

Though the annual open enrollment period (October 15 – December 7), there is a special enrollment period available to all beneficiaries who want to consider a change outside open enrollment period. The “five star” plan special enrollment allows any beneficiary to change from their current plan to a five-star plan anytime between December 8, 2017 through November 30, 2018. This special enrollment period may not be beneficial for all people wanting to change, however, if the formularies of the five star plans do not include at least a majority of their current prescriptions. Contact the State Health Insurance Counseling (SHIC) office for assistance (contact information at the end of this article).

Medicare supplements or Medigap plans – Understand the basics

You might hear Medigap plans referred to as Medicare supplements or supplemental health insurance. A Medigap policy is standardized supplemental health insurance that pays for part or all of the Original Medicare cost sharing you owe. The costs that Medigap plans cover include deductibles, coinsurance amounts and copays. For example, a Medigap plan pays for your Part B coinsurance charges, meaning that it will pay for the 20 percent coinsurance you normally owe when you receive Medicare covered physician services.

It is important to know that Medigap policies only work with original Medicare Parts A and B. If you get your Medicare benefits from a private Medicare plan, known as a Medicare Advantage Plan, you cannot purchase a Medigap plan. In fact, if you already have a Medicare Advantage Plan, it is illegal for anyone to sell you a Medigap policy unless you are switching back to original Medicare.

Congress has recently made some changes that will impact Medigap plans starting Jan. 1, 2020. The Medicare Access and CHIP Reauthorization Act of 2015 states that people who start Medicare in 2020 may not purchase Medigap plans type C or F, which cover Part B annual deductibles. Beneficiaries currently on plans may keep them.

Medigap plan types and premiums

There are ten types of Medigap policies, referred to as “plans,” named after letters of the alphabet. Though the coverage offered within each plan is set by federal law, insurance companies do not have to offer all 10. Regardless of the company selling them, plans with the same letter must offer the same benefits. However, each company may charge a different monthly premium for the same lettered plan.

There are three ways that insurers price Medigap plans.

— Community rated pricing: Monthly premium is based on where you live. For example, people who live in the same county pay the same premium regardless of their age.

— Issue age rated pricing: Monthly premium is based on the age you are when you first purchase the policy. Premiums can increase because of inflation, but not because you get older.

–Attained age rated: Monthly premium is based on your current age. For example, a company may set one premium for people between 65 and 70 years old, and a higher premium for people 71 to 75 years old.

Contact SHIC to learn how to compare Medigap policy coverage and prices.

When can you buy a Medigap policy?

Under federal law you only have the right to buy a Medigap if you are 65 or older and you must buy your policy during a protected time. The protected enrollment times are during your Medigap Open Enrollment Period or when you have a guaranteed issue right.

Your Medigap Open Enrollment Period lasts for six months, starting with the month you are both 65 and enrolled in Medicare Part B. Companies must sell you a policy at the best available rate and cannot deny you coverage. You can buy the Medigap plan of your choice when you are in your Medigap Open Enrollment Period.

You have a guaranteed right for 63 days after you lose or end certain kinds of health coverage. This right requires that the Medigap companies must sell you a policy at the best available rate and cannot deny you coverage. Depending on the reason, you may be restricted to only purchasing certain plans. However, when you have a guaranteed issue right, insurance companies cannot impose a waiting period before covering pre-existing conditions.

Where can I go for assistance with Medicare issues?

If you have any questions, issues or problems related to Medicare, please call SHIC at (888) 575-6611. The North Dakota Insurance Department has been offering the SHIC program to North Dakota beneficiaries for over 25 years. SHIC counselors provide free and unbiased counseling to any Medicare beneficiary. We are available on the internet at www.nd.gov/ndins/shic.