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BEACON Senior News - Western Colorado

Learn about changes at Medicare Monday

Oct 07, 2018 04:51AM ● By Eileen Doherty

Reviewing your Medicare plan and drug coverage is every Medicare beneficiary’s responsibility. Medicare plans can make changes to cost, coverage and providers in their network every year, so make sure to review your plans during Medicare’s open enrollment period from October 15 through December 7. Medicare officials have reported the following changes:

Diabetes prevention

More help is available for individuals who have recently been diagnosed with diabetes and who are enrolled in Medicare Part B. If you meet the requirements, you may be eligible for two years of Medicare Diabetes Prevention Program classes, which use a Center for Disease Control curriculum to help Medicare beneficiaries better manage diabetes, a costly chronic condition both financially and health-wise.

Monitoring opioids

Opioid use will be closely monitored, and in some cases, refills may be denied. Low-income individuals who are identified as high users will have difficulty changing prescription drug plans and may have difficulty getting prescriptions filled if they use multiple pharmacies.

Technology to help determine care

Medicare is advancing telehealth and telemedicine for rural areas, which allows medical professionals to ask questions, observe a patient and determine care using a television monitor with video and audio capabilities, rather than having to travel long distances and delay care.

Lifted therapy caps

Therapy caps for speech, physical and occupational therapy are being lifted. If an individual requires more therapy than the 2018 capitated levels, therapists will have to submit additional paperwork justifying the therapy is medically necessary.

Cost and coverage

Medicare Part D will see some changes with the annual deductible climbing to $415 and the initial coverage amount increasing to $3,820, which will result in beneficiaries paying $1,370 out of pocket before they reach the donut hole. The cost of prescriptions in the donut hole will be 25 percent for name brands and 35 percent for generics. After the cost of prescriptions exceeds $5,100, generics will cost $3.40 and name brands will cost $8.50.

Many drugs are changing formularies, including those embedded in a Medicare Advantage plan. The out of pocket costs are tiered with many drugs on the highest tiers, reaching as much as 50 percent of the drug’s cost. Sometimes paying cash and not using your drug plan can save money.

Learn more at Medicare Monday

Medicare beneficiaries can get the latest information on premiums, deductibles and co-pays for Medicare Part A and B and D, as well as information on Medicare Advantage plans at one of the many free Medicare Monday sessions available throughout Colorado.

Presentations will be in Grand Junction at the Commons at Hilltop on October 15; Carbondale on October 22; and in Montrose and Delta on November 7.

Individuals can schedule a counseling session to discuss their personal Medicare situation, if they need more information or are unable to attend. Call 1-866-294-3971 or visit to make reservations or talk to a counselor.

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