2019 Medicare Advantage Update

October 9, 2018
Rick Gawenda

The Centers for Medicare and Medicaid Services (CMS) has released data that provides important premium and cost sharing information for Medicare health and drug plans offered in 2019. According to the CMS Fact Sheet:

  • Enrollment in Medicare Advantage is projected to be at an all-time high in 2019 with 22.6 million Medicare beneficiaries. This represents a projected 2.4 million (11.5 percent) increase from 20.2 million in 2018. Based on projected enrollment, 36.7% of Medicare beneficiaries will be enrolled in Medicare Advantage in 2019.
  • Medicare Advantage premiums, on average, have steadily declined since 2015 from the actual average premium of $32.91. For 2019, CMS estimates the Medicare Advantage average monthly premium will decline by $1.81 to $28.00 from 2018.
  • Approximately 83 percent of Medicare Advantage enrollees will have the same or lower premium in 2019 if they continue in the same plan. About 26 percent of enrollees staying in current plans will see their premiums decline in 2019. Approximately 46 percent of enrollees in their current plan will have a zero premium in 2019.
  • Access to Medicare Advantage and prescription drug plans will remain nearly universal, with about 99 percent of Medicare beneficiaries having access to at least one health plan in their area. All Medicare beneficiaries will have access to at least one stand-alone prescription drug plan.
  • Nationally, the number of Medicare Advantage plan choices will increase from about 3,100 in 2018 to about 3,700 in 2019 – and more than 91 percent of people with Medicare with have access to 10 or more Medicare Advantage plans in 2019, compared to nearly 86 percent in 2018.
  • The average number of Medicare plan choices per county will increase by 5 plans – up to approximately 34 plan choices per county.
  • Due to new flexibilities available for the first time in 2019, nearly 270 Medicare Advantage plans will be providing an estimated 1.5 million enrollees new types of supplemental benefits:
    • Expanded health-related supplemental benefits, such as adult day care services, and in-home and caregiver support services; and
    • Reduced cost sharing and additional benefits for enrollees with certain conditions, such diabetes and congestive heart failure due to the agency’s reinterpretation of uniformity requirements.
  • Access to important supplemental benefits, such as dental, vision, and hearing continues to grow.
  • The average monthly premium for a basic Medicare prescription drug plan in 2019 is projected to decrease by $1.09 (3.2 percent decrease) to an estimated $32.50 per month. The basic premium for an average Medicare prescription drug plan is projected to decline for a second year in a row.

Click HERE to read it straight from CMS.

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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  1. and these medicare replacement plans do not pay medicare fee schedule. We loose money treating them.

  2. For other commercial Medicare replacement plans (Humana, United Health Care, etc…) should we submit our billing based on the Medicare billing rules (total treatment time) or by the AMA rules (at least 8 minutes per procedure)?

    1. You would need to check with each Medicare Advantage plan to see if they follow Medicare’s “8-minute rule”.

  3. Our contract(s) with these plans do not address AMA vs. Medicare 8-minute rule & it’s been a challenge locating provider manuals for the Advantage plans. Do you have any links to the Advantage plan manuals such as UHC, Aetna, Humana and BCBS? The commercial manuals have been obtained of these carriers but didn’t know if those guidelines would suffice for their Advantage plans. Thank You!