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Medicare Changes To Take Effect with the New Year


With the beginning of each new year comes new changes to health insurance plans, including Medicare. Most of the changes this year comes from the Patient Protection and Affordable Care Act signed into law on March 23, 2010. It is important for seniors to understand these changes so they continue to receive the best possible health care from their providers.

Medicare Premiums
For most seniors, there will be minimal changes to Medicare premiums. Because there is no cost of living increase (COLA) issued by the Social Security Administration, Medicare Part B premiums are prohibited from increasing also. The 2011 monthly premium will remain $96.40 for most existing beneficiaries or $110.50 if you are a new enrollee to the plan in 2010. For those enrolling in 2011, the premium will cost $115.40 per month.

Those who have higher incomes, however, will pay higher premiums. The premiums, based on the 2009 IRS tax return, are as follows:

• Individuals with incomes of $85,000 to $107,000, or married couples filing joint tax returns with incomes of $170,000 to $214,000, will pay $161.50 per month.
• Individuals earning $107,000 to $160,000, couples $214,000 to $320,000, will pay $230.70 monthly.
• Individuals with incomes of $160,000 to $214,000, couples $320,000 to $428,000, will pay $299.90 each month.
• Individuals over $214,000, or couples above $428,000, will pay $369.10 per month.

Medicare beneficiaries with higher incomes will also have a surcharge on Part D premiums. Those with individual incomes of $85,000 or more (or over $170,000 for joint filers) will pay an additional $12 to $69.50 per month, depending on their income, for the prescription drug plan.

Medicare Deductibles and Co-Pays
All Medicare Part B beneficiaries will see a rise in their deductible, which will increase from $155 in 2010 to $162 in 2011.
The Medicare Part A hospital insurance deductible will also increase. For hospital stays up to 60 days, the cost will increase from $1100 to $1132. For stays lasting longer, the per day rate will be $283 for hospital stays lasting between 61 to 90 days and $566 per day for 91 to 150 days.

The skilled nursing facility co-payment for days 21 to 100 will increase from $137.50 per day to $141.50 per day.

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Donut Hole Discount
The “donut hole” describes a coverage gap that begins when you and your drug plan have spent $2840 on prescription drugs. Until the end of the gap is reached, at $4550, Medicare beneficiaries previously paid full price for their medications. Beginning today, seniors who have reached the coverage gap will receive a 50% discount when purchasing Medicare Part D covered, brand-name prescription drugs. If you use generic drugs, you will receive a 7% discount after reaching the donut hole.

While you might think that this benefit will extend the donut hole (because you’ve spent less money toward reaching the end of the gap), the full price of the prescription drug is counted toward the goal of $4550 – not the discounted cost you pay.

Free Preventive Care Screenings
If you are enrolled in a traditional Medicare Plan, you will receive preventive services and screenings such as flu shots, pneumonia vaccines, cholesterol screenings, mammograms, cervical cancer screenings and bone-mass measurement at no additional cost. Other preventive care services include nutritional counseling for a chronic condition such as diabetes.

Unfortunately, this benefit does not extend to those who have Medicare Advantage Plans.

Medical Equipment Purchase
Starting on January 1st, Medicare will only pay for certain medical equipment that comes from a preferred vendor. This applies to items such as feeding-tube supplies, mail-order diabetic supplies, oxygen equipment, hospital beds, and motorized scooters.

Physician Medicare Benefits
Your primary care doctor may also receive a new benefit from Medicare this new year. As part of the healthcare reform act, certain primary care physicians will receive a 10% bonus for services rendered to Medicare recipients. This hopes to encourage more physicians to provide primary care and extends to those trained in internal medicine, family practice, pediatrics, and geriatrics.

For more information on all Medicare changes for 2011, visit www.medicare.gov or call 1-800-633-4227.

And if you missed open enrollment for Medicare, which ended on December 31st, you can still enroll during a special open period between now and March 31st, however, you may be required to pay a late penalty based on the length of the delay. And if you are currently enrolled in a Medicare Advantage plan but wish to change to a traditional plan, you may be able to during a “disenrollment” period that lasts until February 14th.