Each New Year brings a similar feel with it, resolutions, goals and changes.  For the medical world it means more of the same; insurance changes, deductibles and unpaid claims.  That’s not to say it’s a bad thing, it simply is the way it is.  Each year in January Medicare recipients, whether it be for medical, hospital or drug coverage, have their deductibles reset. This is also when many of the insurance company’s policies are renewed. This may be why something that was no charge December 31st now has a co pay, requires prior authorization or is simply not covered on January 2nd.  Insurance plans change, formularies change, policies and deductibles change.  Now, as we do deal with this on a daily basis, and will do our very best to provide you answers to why these changes have occurred, we cannot possibly know all of the thousands of insurance formularies on the market, so we may not have all the answers immediately.

What we do know as a general rule is this: for private insurance those policies are renewed whenever your employer has set the policy to renew, so this may be at the beginning of the year but could occur at any time.  For Medicare Part B, there is a $185 deductible and after that a 20% co pay for medical supplies and equipment in lieu of a secondary insurance (secondary plans may pick up some or all of this).  Medicare may also change its allowed cost, so the 20% you paid last year may also be different i.e.: test strip allowable of $10 had a co pay of $2 when increased to $12 allowed the co pay would be $2.40.  For Medicare Part D, the deductible is 415$ for 2019 and the initial coverage is $3820.  After surpassing the $3820 threshold you would then enter the coverage gap, affectionately labeled the donut hole.  Once in the donut hole, your out of pocket maximum is $5100. That $5100 is the total of all of your expenses combined, not an additional $5100.  In this gap period your insurance company does not pay anything toward the claim, they do however negotiate their lowest price and in the case of some name brand medications get you some coverage from the drug manufacturers as well.  All of this is subject to the patient individuals plan, monthly premium and additional assistance, but these are Medicare’s guidelines for 2019.

We will do our very best to make sure that you are able to get all of the information that you need, and explain your charges accordingly.  I hope this gives a little insight into the changes that each New Year brings in regards to your insurance coverage.

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