There has been considerable discussion of Medicare over the past year most focusing on how to finance this healthcare program in the future. But there are a number of changes that will take place in 2012, many of which will provide additional coverage. The bad news? Well, premiums will increase. Here are some of the major changes.
New enrollment periods
Beginning October 15 through December 7 of this year, you can enroll for both drugand health-plan benefits at the same time! The plans you enroll in during this time begin January 1, 2012. You can also disenroll from Medicare Advantage plans between January 1, 2012 and February 14, 2012 and switch to Original Medicare. Any changes go into effect on the first day of the following month. So if you disenroll January 15, 2012, the change is effective February 1, 2012.
New Medicare Monthly Premiums
Type of Monthly Premium |
Amount of Monthly Premium |
Part A monthly premium (for people who pay a premium) |
$451 |
Part A Late Enrollment Penalty |
+10% |
Part B monthly premium |
$99.90 Higher-income consumers may pay more. |
Part B Late Enrollment Penalty |
+10% for each full 12-month period that you could have had Part B, but didn't sign up for it |
Part C monthly premium |
Varies by plan |
Part D monthly premium |
Varies by plan Higher-income consumers may pay more |
Part D Late Enrollment Penalty |
Depends on how long you went without creditable prescription drug coverage |
Preventive services
Medicare now covers screening and counseling for alcohol misuse, depression, and obesity.
Obesity Screening and Counseling
If you have a body mass index of 30 or more, Medicare covers intensive counseling to help you lose weight. This counseling may be covered if you get it in a primary care setting, where it can be coordinated with your comprehensive prevention plan. Talk to your primary care physician or practitioner to find out more.
Abdominal Aortic Aneurysm Screening
Medicare covers a one-time screening abdominal aortic aneurysm ultrasound for people at risk. You must get a referral for it as part of your one-time “Welcome to Medicare” preventive visit. You pay nothing for the screening if the doctor or other health care provider accepts assignment.
Alcohol Misuse Counseling
Medicare covers one alcohol misuse screening per year for adults with Medicare (including pregnant women) who misuse alcohol, but aren’t alcohol dependant and are competent and alert during counseling. People who screen positive can get up to 4 brief face-to-face counseling sessions per year. A qualified primary care doctor or other primary care provider must provide the counseling in a primary care setting. You pay nothing if the doctor or other health care provider accepts assignment.
Depression Screening
Medicare covers one depression screening per year for all people with Medicare. The screening must be done in a primary care setting that can provide follow-up treatment and referrals. You pay nothing if thedoctor or other health care provider accepts assignment.
Medicare Advantage improvements
If you’re enrolled in a Medicare Advantage “managed care” plan, rejoice. You’re about to get some protection from the higher out-of-pocket costs you faced compared with people who chose standard Medicare coverage. The areas affected are chemotherapy, kidney dialysis, and skilled nursing care.
Most chemotherapy is covered under Part B of Medicare (outpatient services). In 2012, the most you can be charged out of pocket is a 20 percent coinsurance or a $75 co-pay. If your chemotherapy is administered while in the hospital, it’s covered as part of your entire hospitalization.
Kidney dialysis is also covered under Part B and carries either a 20 percent coinsurance or a $30 co-pay. In 2012, skilled nursing facility stays cost no more than $100 for the first 20 days, then $146 per day for days 21 through 100. After 100 days, you have to pay the entire daily cost.
Beginning in 2011, Medicare Advantage plans also had to set a maximum annual out-of-pocket amount for all hospitalization and outpatient services. They also had to cover more of your costs if you enroll in clinical trials.
Cheaper prescription drugs
If you’re covered under the Part D prescription drug benefit and regularly take medicine, get out your piggy bank; you’re due for some savings! Put simply, the well known “donut hole” will be shrinking.
In 2012, most people will hit a coverage gap for prescription drugs (called the donut hole) after $2,930 in total drug costs (what you spend plus what your drug plan spends for medications). Then you have to pay a percentage of all drug costs until you’ve spent $4,700. If you reach $6,657 in total drug costs before the end of the year, you pay a five percent coinsurance for drugs, or $2.60 for generic and $6.50 for branded drugs, whichever is more, for the rest of the year.
The good news is that the donut hole is shrinking. In 2010, you got a $250 rebate check to help cover costs in the donut hole. Beginning in 2011, drug manufacturers had to slash the cost of all brand-name drugs (i.e., Lipitor, Norvasc, Fosamax, etc.) in half for those who reached the donut hole. Also this year, generic drugs are being discounted by seven percent in the donut hole. In 2012, that doubles to 14 percent. By 2020, the donut hole disappears and you pay just 25 percent of any brand or generic drug once you reach the Part D coverage limit.
Another change: If you’re covered by both Medicare and Medicaid and are in a nursing home or receive long-term care services in your home, you don’t have to payany drug co-payments.
Photo: http://www.flickr.com/photos/72131668@N08/6510494453/sizes/m/in/photostream/
Related posts:
- No Increase in Medicare Prescription Drug Premiums
- Medicare Changes for 2011
- Elder Adults Can Save Money on Medicare Costs
- Medicare Adds Services for Cardiovascular Disease
Randy Ryder is a Professor Emeritus at The University of Wisconsin-Milwaukee and is a publisher of Elder Parent Help.