The new year brings changes to Medicare, many of them a result of the new Affordable Care Act. Here’s a brief rundown of what to expect in 2011 and how you can take control and make sound decisions.1) Original Medicare will cover the full cost of an annual wellness visit with your doctor. The yearly checkup will include routine measurements such as your blood pressure, a review of your prescriptions and medical history, and a personal assessment of any risks to your physical and mental health. Until now, you’ve been entitled to one “Welcome to Medicare” exam during the first year you sign up for Medicare’s Part B, which covers outpatient services. If you’re enrolled in a private Medicare Advantage health plan, check with your insurer about whether it, too, will cover the wellness visit at no cost in 2011.
2) If you have a drug plan and reach the coverage gap, or “doughnut hole,” you’ll receive a discount on your prescriptions. You’ll get 50 percent off the price of brand-name drugs and 7 percent off generics. Even though you’ll pay less for a brand-name drug, you can count the prescription’s full price toward the amount you’re required to spend on drugs to qualify for catastrophic coverage. That way, you’ll enjoy lower out-of-pocket costs while in the “doughnut hole,” but you’ll still become eligible for Medicare’s catastrophic coverage as quickly as you would without the discount.
3) If you have Original Medicare, you’ll pay nothing out of pocket for most preventive services.
Until this year, you’ve usually paid 20 percent of the Medicare-approved amount for lab tests and screenings after you met your annual deductible. But starting in 2011, you won’t have to worry about a deductible, co-payment or coinsurance for a broad range of preventive services, including colonoscopies, mammograms, Pap tests and prostate cancer screenings. If you’re in a private Medicare Advantage plan, contact your insurer to find out whether it has also eliminated out-of-pocket costs for tests and screenings.
4) Medicare Advantage health plans are now required to have annual out-of-pocket maximums and other consumer protections. In the event you need an expensive treatment, you’ll be protected from exorbitant out-of-pocket costs. For many Advantage plans, out-of-pocket expenses (excluding premiums and prescription costs) will be capped by law at $6,700 in 2011. Some plans have voluntarily set lower maximums. In addition, if you’re in a private health plan, you can no longer be charged more for some services (like chemotherapy) than if you were in Original Medicare.
5) Your Medicare premiums may change. Most people on Medicare will pay the same Part B premiums this year as they did in 2010 — either $96.40 or $110.50 per month.
But there are several exceptions.
If you enroll in Part B for the first time in 2011, or if your premiums aren’t deducted from your Social Security check, you’ll pay $115.40 a month. For higher-income beneficiaries (single people with annual taxable incomes over $85,000 or married couples with incomes above $170,000), Part B premiums will range from $161.50 to $369.10. Plus, starting this year, beneficiaries in those income brackets will pay a monthly surcharge of $12 to $69.10 for their prescription drug coverage.
6) There are new times to switch your coverage.
Dissatisfied with your private Medicare Advantage health plan? A new annual “disenrollment” period allows you to switch to Original Medicare and a drug plan between Jan. 1 and Feb. 14. That replaces a January-to-March enrollment period when you could switch between Original Medicare and the Medicare Advantage program or move from one private plan to another.
In 2011, you’ll have more time to choose and join a private health or drug plan when the annual open enrollment period gets an earlier start than usual in the fall.
In past years, it has run from Nov. 15 to Dec. 31. This year, it will kick off on Oct. 15 and wrap up Dec. 7. As always, your new coverage will take effect Jan. 1.
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