Everyone in a hospital or healthcare system works hard to offer quality healthcare in a caring manner for patients at every life stage. An essential and substantial segment of our patient population receives Medicare and deserves respect from reception through check-out and beyond. In October 2018 the Centers for Medicaid & Medicare Services announced revisions to Medicare Part A, Part B, Part C (Medicare Advantage), and Part D that are now in effect. Compassionate patient care depends on knowing the changes and how to assist in building and sustaining strong relationships.

How has Part A changed?

Medicare Part A covers inpatient hospital services, short-term nursing facility care, hospice and some in-home care. For almost all Medicare patients Part A is premium-free.

  • The inpatient deductible has increased $24, from $1,340 in 2018 to $1,364 in 2019. This covers the first 60 days of Medicare-insured inpatient care.
  • Your Medicare patients also are now seeing increases of $6 per day for co-insurance for the 61st through 90th days of hospitalization, from $335 per day in 2018 to $341 per day in 2019.
  • Co-insurance for days 21 through 100 of skilled nursing facility care have increased $3 per day, from $167.50 in 2018 to $170.50 in 2019.

How has Part B changed?

Medicare Part B covers physician services, outpatient care, durable medical equipment and other benefits that do not fall under Part A.

  • The standard monthly premium for your patients who are enrolled in Part B has increased from $134 in 2018 to $135.50 for 2019. An estimated 2 million beneficiaries will pay less than the full standard amount in 2019, due to a provision that keeps increases in Part B premiums from exceeding increases in Social Security benefits.
  • Your Medicare patients’ annual deductible for Part B is $185 in 2019, up from $183 in 2018.

How has Part C (Medicare Advantage) changed?

Medicare Part C offers your patients the option to select a private Medicare Advantage plan, which takes the place of fee-for-service Parts A and B.

  • An increasing number of your Medicare patients may find that Medicare Advantage is best for their needs. In 2019 Medicare Advantage enrollment is projected to reach an all-time high of 22.6 million patients or 36.7% of Medicare beneficiaries.
  • Medicare Advantage premiums have steadily declined since 2015. CMS estimates that the average 2019 monthly premium will be $28, about $2 less than the 2018 average.
  • There will be approximately 3,700 Medicare Advantage plan options in 2019. More than 91% of Medicare patients can pick what works best for them from 10 or more choices.

How has Part D changed?

Prescription drugs are a part of many of your older patients’ daily care, and CMS continues to work with Part D prescription drug plan sponsors to increase the number of plans available. Further good news for your patients:

  • The average monthly premium for a basic plan in 2019 is anticipated to decrease by 3.2% to $32.50.
  • The so-called “donut hole” of Part D coverage will continue to shrink. The donut hole gap in coverage leaves patients who have paid $3,820 in drug costs in a benefits period with an increase in the price of prescriptions. In 2019 patients in this coverage gap are responsible for no more than 25% of the price of brand name drugs. In 2020 the same 25% limit will extend to generics.

How can providers maximize Medicare payments?

Working together, providers, patients, and an insightful revenue cycle management team can bring about payment solutions that benefit everyone. The patient experience a hospital or health system offers depends on field knowledge, experience, and longevity. Healthcare Claims Management brings these qualities to each stage of your revenue cycle. Medicare can be dizzying, and a team that ensures your revenue is well-managed and your patients feel not just seen but cared for offers the best outcomes for all.