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  • Writer's pictureKaren McPhail, RN, MSN

Medicare and 2020 Medicaid Eligibility Changes !

Navigating Medicare and Medicaid options is never easy. Many people become overwhelmed by these processes, the many options, the changing coverage and eligibility, and available resources to assist them! This blog entry will attempt to provide some of the basics for moving forward in positive way!!!

The Centers for Medicare and Medicaid Services recently announced the new 2020 rates. For about 70% of Medicare beneficiaries, the premiums will rise approximately 7% to $144.60 a month, which is an increase from $135.50 in 2019. The $9.10 monthly increase follows a smaller $1.50 rise this year. You can shop and compare plans to find ones that meet your needs by visiting Downloading the 2020 Medicare and you booklet also advised -

So to start, what is Medicare?

Medicare is a federally funded program that provides options for health insurance to US citizens and legal residents generally over the age of 65. Medicare is also available for individuals with certain disabilities. There are currently around 44 million medicare beneficiaries in the U.S., with 15 percent of the U.S. population enrolled in the Medicare program. Due to the growing aging population, Medicare enrollment is expected to rise to 79 million by 2030. (

An individual may first sign up for Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

During the annual enrollment period they may make changes to their coverage!

The system has recently improved their automated aspects:

The “What’s covered” mobile app delivers reliable (Original Medicare) Part A and Part B coverage information right on your mobile device. You can download it for free on both the App Store and Google Play.

You can now compare national average prices for certain procedures performed in both hospital outpatient departments and ambulatory surgical centers. Visit easier access to your personal Medicare information

They have improved to make it easier to find what you need, with added new features, like the ability to print an official copy of your Medicare card.

They also connected to Blue Button 2.0—a secure data connection that now lets you share your health information with a growing number of mobile apps, third party applications, health-related services, and research programs.

And coming soon you will be able to easily find and compare quality Quality information about Medicare-participating doctors, hospitals, nursing homes, dialysis facilities, and other care providers will soon be available in one easy-to-use place. You will be able to compare quality ratings, cost information, and other details to help you make informed choices. This service will be coming in late 2019 to

Medicare has several standard, original parts:

Part A (Hospital Insurance)

Helps cover :Inpatient care in hospitals, limited skilled nursing facility care (does not cover long term convalescent care needs, this is private pay), Hospice care, Home health care.

Part B (Medical Insurance)

Helps to cover:

• Services from doctors and other health care providers

• Outpatient care

• Home health care

• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)

• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Part D, Prescription drug coverage Helps cover:• Cost of prescription drugs (including many recommended shots or vaccines). Part D plans are run by private insurance companies that follow rules set by Medicare.

Additional Medicare Options:

There are several options in terms of the Medicare programs:

Individuals may select the "original" Medicare (Parts A and B), which is provided through the federal government.

In addition, individuals may also purchase an additional prescription drug plan and /or Medicare Supplement or Medigap plan through one of the standardized plans, which is provided by private insurance companies that contract through Medicare.

In terms of Medicare Supplement or Medigap plans:

See to compare medical plan types.

Some changes- Starting January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible.

Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.

Potential Penalties for not Enrolling in Medicare:

When an individual turns 65 and first becomes eligible for Medicare, they will automatically be enrolled in the "original" Medicare program (Part A and B). One is eligible for Medicare Part A premium free beginning at this age, if they or their spouse were employed and paid into the system for at least 10 years.

If you are not eligible for premium-free Part A, and you don’t buy it when you’re first eligible, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could’ve had Part A but didn’t sign up.

Example: If you were eligible for Part A for 2 years but didn’t sign up, you’ll have to pay a 10% higher premium for 4 years. (

If you did not sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12 months in the period that you could’ve had Part B, but didn’t sign up for it. If you’re allowed to sign up for Part B during a Special Enrollment Period, you usually don’t pay a late enrollment penalty.

Example: Mr. Smith’s Initial Enrollment Period ended December 2016. He waited to sign up for Part B until March 2019 during the General Enrollment Period. His coverage starts July 1, 2019. His Part B premium penalty is 20%, and he’ll have to pay this penalty for as long as he has Part B. Even though Mr. Smith wasn’t covered a total of 27 months, this included only 2 full 12-month periods. (

Medicaid and Medicare:

Important- If you have Medicaid, you should still sign up for Part B.

Medicare will pay first, and Medicaid will pay second. Medicaid may be able to help pay Medicare out-of-pocket costs (like premiums, deductibles, coinsurances, and copayments).

Medicaid Changes and Guidelines:

On January 17, 2020, the Centers for Medicare and Medicaid Services (CMS) adjusted the federal poverty levels, affecting income guidelines for Medicaid eligibility.

Individuals who recently applied for Medicaid coverage and narrowly exceeded income guidelines may now be eligible.

Under the new guidelines, a childless adult seeking Medicaid coverage may be eligible if he or she has an annual income at or below $17,609.

Adults in a family of three may qualify if the total household income is at or below $29,974.

For the new 2020 Medicaid Eligibility Requirements see-

Seek guidance from a professional when applying for Medicaid as missing a date or failing to submit paperwork needed can be financially disastrous and lead to multiple denials.

Choices are Important:

Since these are VERY important decisions I recommend that my clients speak with the Virginia Insurance Counseling and Assistance Program (VICAP) or a trusted, licensed, trained, and certified insurance agent to discuss their options! These services are free of charge to individuals seeking policies so it is a no lose situation! Start the process out right by getting the guidance you need! Feel free to reach out via my contacts tab with any questions! I am here to help! Some links are below also for reference.


Sources / Additional Resources below:


Medicare Portal:

Virginia Medical Plans:

Medicare vs. Medicaid: Key Differences and What Is Covered

What’s the Difference Between Burial Insurance, Life Insurance, and Funeral Insurance? Why You

Should Get Health Insurance

Buying Private Health Insurance Will My

Insurance Cover a Retirement Home or Assisted Living?

Requirements for Long Term Disability

Do You Need Disability Insurance?

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