How Are Insurance Plans Changing in 2019? An Expert Weighs In

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Topics include: Financial and Insurance

What changes can you expect to see when it comes to your insurance? As a patient, it can be difficult to navigate the ins and outs of coverage. Healthcare insurance expert Stacey Worthy from Aimed Alliance shares her expertise. Andrew and Stacey discuss the specifics of Medicare coverage and what it means for patients. Andrew and Eliot Finkelstein also discuss their own insurance situations and what other patients can expect.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

So, what’s pending related to Medicare rules? When would this kick in? Maybe we need to go the “Mad About That.” 

Stacey Worthy:           

Yeah. So, under the Affordable Care Act, there was a provision that had sort of caps—or, not really caps, but they had limits on what you would be paying, the threshold, that catastrophic phase of the Part D plan. Typically, the way it works is you’re in the deductible phase, you pay 100 percent of the medication until you meet the deductible. Then, you go on to the initial coverage, where you’re paying 25 percent co-insurance until you get into that donut hole. And then, in 2019, I think you get into the donut hole when you reach about $3,800.00.

Then, you’re in the donut hole where you have really high co-insurance until you meet that threshold for catastrophic coverage which, in 2019, is gonna be about $5,100.00. In 2020, that’s when the ACA provision is scheduled to sunset, so that catastrophic coverage threshold rises to $6,300.00, which is a big chunk of change. So, that’s why we want to encourage people to write to Congress and ask them to fix this by enacting a path on out-of-pocket costs for Part D plans. 

Andrew Schorr:           

All right, let’s see—I understand. So, just for the Medicare folks—and, let’s face it, a lot of people—Eliot, you’re younger. How old are you?

Eliot Finkelstein:         

I’m 60.

Andrew Schorr:           

Okay. So, you’ve got another five years before—maybe they’ll change that. Who knows?

Eliot Finkelstein:         

Hopefully.

Andrew Schorr:           

Yeah. But, right now, I’m 68, so for my friends who are 65 or older and on Medicare, we then are paying—reach the catastrophic level pretty quick. In 2018, was it $3,800.00?

Stacey Worthy:           

That’s the initial coverage period. 

Andrew Schorr:           

Okay. But, you’re saying in 2019, it’s gonna be yet higher?

Stacey Worthy:           

Yeah, so, for the catastrophic coverage, it’s $5,100.00.

Andrew Schorr:           

And then, the plan is for 2020, over $6,000.00?

Stacey Worthy:           

Yes.

Andrew Schorr:           

Whoa. So, we pay that? 

Stacey Worthy:           

Mm-hmm.

Andrew Schorr:           

And then, I think, it drops to—we have a co-pay of 5 percent, right?

Stacey Worthy:           

Yes, exactly.

Andrew Schorr:           

Then, I have a question – five percent of what?

So, there’s been a question whether we—the Medicare consumer—I just wanna stick with Medicare for a second—we, the Medicare consumer, are paying basically five percent of the retail cost, if you will, even though whoever was providing us the medicine may be getting rebates and pocketing the money. Am I right?

Stacey Worthy:           

Yes

Andrew Schorr:           

What do we do about that? 

Stacey Worthy:           

That requires additional reform. So, we need reform of the PBM system, and making sure that PBMs are not pocketing those rebates that they’re passing… 

Andrew Schorr:           

…quite frankly, there was an affair in the Rose Garden at the White House, and however you feel about Trump or Republican or Democrat, that was the discussion. Are there these middlemen pocketing money and us poor cancer patients or other people with expensive medicines getting hammered with higher co-pays when those guys are making money in the middle?

Stacey Worthy:           

Exactly. So, basically, what’s happening is they’re reclassifying rebates that should be passed on to the insurers, and then ultimately to patients—plan enrollees—as administrative fees, and then they get to keep that money instead of passing that savings on.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on September 9, 2019