Senior Life Matters

8/1/18: My insurance coverage went up for 2019. What should I do?

Question: I just received correspondence from my insurance company informing me of my 2019 coverage. The price went up. What should I do? Did all the other plans raise their premiums?

Answer: Happy Insurance Season! It is October 1st, and I am knee deep in learning about the changes to the insurance plans for 2019!! Wow, there are interesting changes, and some of the plans hardly changed much at all!

That means the answer to your question is “It Depends!”

I have started to hear from a number of people that have received their Annual Notice of Change (ANOC) from their insurance company. This letter is a required notification they must send to every individual to describe the insurance coverage in the New Year (2109). Medicare Part D Prescription Drug Plans (PDP’s) and Medicare Advantage Plans (MA) are required to deliver that ANOC letter to you before 9-30-18. Some insurance companies mail them out weeks before that. Some insurance companies stick right to that 9-30-18 required date.

This ANOC packet includes information regarding current coverage (2018) and then next year’s coverage (2019). Usually the most important information is on the first or second page of the booklet/packet.

When these packets arrive, I begin to hear from clients letting me know what they say and asking questions about what to do.

One of the biggest changes overall this year is the change in the coverage gap. During the Coverage Gap in 2019, the Brand Name Medications will be 25% to you. That is a fixed number for you! If you take brand-name medication, like inhalers, or insulin, or others this could mean lower costs for you, when and if you hit the Coverage Gap.

Another big change is how they calculated the “True Out Of Pocket Cost” (TRooP). In 2019 a larger percentage of costs you don’t pay (Brand Name Discount) goes towards your Catastrophic Coverage calculation. This means some individuals will reach this last stage of coverage sooner, and see even further reductions in their pharmacy costs.

At this point, we know there are three new Stand Alone Drug Plans. We know there are one new Medicare Advantage HMO plan. We know there are some name changes. We know there are lots of changes to the plans premiums, deductibles, and drug coverage. It looks like about a third of the plans have raised the premiums and a third of the plans have lowered the premiums, and a third of the plans have kept the premiums the same.

Now remember that the premium you pay to the insurance company is only a small piece of the entire puzzle. The deductible may have changed. The co-pays and Tiers of the medications may have changed. The pricing structure at your pharmacy may have changed.

Each year some of those changes are dictated by Centers for Medicare & Medicaid Services (CMS), and some are decisions of the individual plans. In 2019, the CMS standard Medicare Part D plan allows for a $415 deductible, the initial coverage phase lasts until your total drugs costs reach $3820. The next phase is the Coverage Gap (“Donut Hole”). This year Brand Name Medications will cost 25% and Generic Medications will be 37% of the total cost. The Catastrophic Coverage stage is reached when your spending is just over $8,000. The Catastrophic Coverage continues to be not more than 5% or $3.40 for generic medications and $8.50 for all others.

Remember that each Insurance Plan classifies medications into ‘Tiers’. The medications you take can be the same, but the Tier they are assigned to can change year to year. So review that packet to see if the medications you take are still on the same tier.

If you have a Medicare Advantage Plan your insurance will still mail you an ANOC, but it will include much more information. It will cover the monthly premium for the plan, the Part D prescription drug benefit AND the Health Insurance co-pay structures. So there are a lot more changes that can be made to the plan.

Your Medicare Advantage Plan may still have a $0 monthly premium, but the amount you pay at providers and for medical procedures can change. The Prescription Drug Benefit will also change.

Now you see why I get so excited about the October 1st information! There is so much new and exciting information to review! That ANOC letter and packet of information you have just received has a lot of useful information you should review. After reviewing the numbers and information, you can make your decision to change your insurance or not. If you want to change your insurance you would have that October 15th to December 7th timeframe to make that change. You have 53 days to make any changes you would like to make to your insurance products.  If you decide to keep the plan you currently have you don’t have to do anything. It will just continue to cover you in the 2019 calendar year.

If you decide that you don’t want your plan and would like to make a change that October 15th to December 7th is the time to make that change. Don’t put it off, the time goes quickly.

Happy Insurance Season! It is finally here!

To contact Janell Sluga, GCMC with questions or concerns, please call 716-720-9797 or e-mail her at