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The 2019 Medicare & You Handbook is online and available for download

Category: General Medicare
Published: Sep, 20 2018 03:09:17


If you are a Medicare beneficiary, you should receive a printed version of the Medicare & You Handbook prepared by the Centers for Medicare and Medicaid Services (CMS or Medicare) sometime in late-September or early-October.

Your printed version of the Medicare & You Handbook will contain details of the stand-alone Medicare Part D prescription drug plans and Medicare Advantage plans available in your area (that is, within your state or region for Medicare Part D plans - or within your county/ZIP for Medicare Advantage plans).

2019 cms medicare and you handbook
The Medicare & You Handbook is also available electronically in a PDF format and you can download it from the Medicare website or on Q1Medicare.com at: Q1Medicare.com/PartD-MedicareAndYouCMSGuideToMedicare.php.

The electronic Medicare & You Handbooks (english and spanish) contains the same general Medicare information as your printed Handbook.  However, the electronic document naturally does not include specific information on the local or regional Medicare Part D prescription drug plans or Medicare Advantage plans that are available in your area.

For reference, we also offer a Medicare & You Handbook archive with versions of the Handbook back to 2006.

A few highlights of the 2019 Medicare & You Handbook
You may notice that 2019 Handbook has a slightly different look and feel as compared to the 2018 Medicare & You Handbook - and even varies from the 2019 "draft" Handbook CMS released earlier this year to gather feedback from the Medicare community.  Here are just a few highlights of the 2019 Handbook:
  • The "newly reinstated" Medicare Advantage plan Open Enrollment Period (OEP) begins January 1st and continued through March 31st is introduced and the Handbook describes how you can make one change to your Medicare Advantage plan during this additional enrollment period (change to another MA/MAPD plan or drop your plan and add a Medicare Part D plan). (see p.3)

  • Medicare Advantage plans are not listed under the "What are the Parts of Medicare" (p.4), only Medicare Part A, Medicare Part B, and Medicare Part D are summarized with reference to where in the Handbook these topics are explained in more detail.  Medicare Advantage plans are introduced on the following pages as an option to Original Medicare.

  • On page 56, the topic of "Organization determinations" is introduced.  In the 2019 draft Handbook, the term "preauthorization" was used to describe the benefits of prior authorization as a means of determining whether "an item or service will be covered by the plan."  Not surprisingly, Medicare advocates objected to CMS framing prior authorization as a benefit to the Medicare Advantage plan member.  The final 2019 Handbook provides a more balanced statement: "You (or a provider acting on your behalf) can request to see if an item or service will be covered by the plan in advance. Sometimes you must do this [prior authorization] for the service to be covered. This is called an 'organization determination.' If your plan denies coverage, the plan must tell you in writing."  As a note, the topic of "prior authorization" is also introduced on page 7 when comparing Medicare Advantage plans and Original Medicare.

Medicare Part D prescription drug plan (PDP) information in your area
If you would like to review the coverage details of any stand-alone Medicare Part D prescription drug plan in your area, you can use our PDP-Finder tool found here: PDP-Finder.com/FL

(This link is showing an example of Medicare Part D plans in Florida, but you can change the state to your state.)


Medicare Advantage plan (MA, MAPD, MSA, and SNP) information in your area

You can also review the details of any Medicare Advantage plan (with or without prescription drug coverage) using our MA-Finder tool.  Here is an example link of all the Medicare Advantage plans available in Miami-Dade county: 
MA-Finder.com/33142

(Again, you can change the ZIP Code to your own ZIP Code.)






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Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.