Medicare: What’s New for 2012

© iStockphoto/ThinkstockIf there’s one thing that’s constant about Medicare, it’s change. That applies to the benefits you get, the cost

physician's stethescope© iStockphoto/ThinkstockIf there’s one thing that’s constant about Medicare, it’s change. That applies to the benefits you get, the cost of those benefits, and even the deadlines for signing up or switching plans. Here’s a look at some of the major changes that occurred in 2011 and those pending for 2012.

New enrollment periods
Beginning October 15 through December 7 of this year, you can enroll for both drug and 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.

Preventive services
Beginning in 2011, your co-payment for most preventive services (think Pap tests, flu shots, and screening mammograms) is… nothing! That includes big-time tests like colonoscopies, bone density tests, prostate cancer screenings, and diabetes tests. It also includes an annual “wellness exam.” You will, however, have to pay your share of any doctor or hospital services for all tests except the wellness exam.

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 pay any drug co-payments.

Higher Part D premium
Here’s a bit of bad news. If you earn more than $85,000 a year, or you and your spouse earn more than $170,000 a year, then your monthly premium for Part D is going up. The table below shows your estimated additional monthly payments.

If your annual income in 2009 was . . . …you pay*

Filing an Individual Tax ReturnFiling a Joint Tax Return
$85,000 or less$170,000 or lessyour plan premium
$85,001 – $107,000$170,001 – $214,000$12 + plan premium
$107,001 – $160,000$214,001 – $320,000$31.20 + plan premium
$160,001 – $214,000$320,001 – $428,000$50.10 + plan premium
$214,000 or more$428,000 or more$69.10 + plan premium

*Estimated amounts only

Easier appeal
Admit it, appealing a denial for a prescription drug you think should be covered but your prescription plan doesn’t is a daunting task. Forms, forests of phone trees, voice mail. Well, in 2012 it all gets easier. You’ll be able to have instant access to a single appeals process—no matter who provides your Part D coverage—through a web site and toll-free phone number.

Review of your medications
Within the next couple of years, if you have a chronic condition like diabetes, asthma, high blood pressure, or congestive heart failure, you should receive a free annual review of all your medications, either in person, online, or on the phone. The review is called Medication Therapy Management or MTM. It’s a great benefit because studies find that older people are often prescribed potentially dangerous drugs, medications they don’t need, and drugs that interact with one another, making them sicker. Check with your prescription drug plan about enrolling for the MTM program.

Changing government payouts
Beginning in 2012 and continuing for the next several years, the federal government will pay Medicare Advantage insurers slightly less per patient. Whle next year’s decline is small — 0.16% less per patient — it comes at a time when health care costs are rising.  What will that mean for Medicare Advantage premiums or service levels? It’s too soon to tell. But there’s good news for high-performing Medicare Advantage programs. Those that get high rankings from its customers will receive bonus payments from the government, starting in 2012.

Learn more about Medicare.

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