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The A,B,C’s (and D’s) of Medicare in 2011
Cindy Dubansky, MSW, LICSW C-ASWCM
The A,B,C’s (and D’s) of Medicare in 2011
Cindy Dubansky, MSW, LICSW C-ASWCM
People on Medicare will see many changes to Medicare in 2011. Not all the information can be included here, but more details are available from the information resources listed at the end of this article.
Medicare is a federal health insurance program for people 65 or older, people under 65 with certain disabilities and people of any age with (ESRD) End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
There are four parts to Medicare:
Medicare Part A covers hospital inpatient care, Skilled Nursing Facility (SNF) care, home health care, hospice care and blood. In 2011, the deductible for hospital days 1-60 will be $1,132 before Medicare starts paying hospital expenses. Copayments may then apply, depending on the length of the hospital admission.
Medicare Part B covers physician services, Durable Medical Equipment, prosthetics, orthotics, supplies, ambulance services, preventive care services, outpatient Physical, Speech and Occupational Therapy, blood, Chiropractic care, outpatient mental health services, home health care, X-rays, lab tests and limited prescription drugs. In 2011, the annual deductible will be $162 before Medicare starts paying Part B expenses. Then a 20% coinsurance applies for Part B services, except outpatient mental health services, for which the coinsurance will be 45%.
Medicare Part C is also known as Medicare Advantage, a series of private health insurance options (like an HMO or PPO) that must cover the same services and benefits available through Original Medicare. People who enroll in a Medicare Advantage plan receive all of their Medicare Part A, B and sometimes Part D benefits through the plan.
Medicare Part D is Prescription Drug Coverage.
Some of the Changes for 2011:
Beginning Fall 2011, (for the 2012 plan year) the Annual Election Period will change to October 15, 2011- December 7, 2011. You may make changes to your Medicare Advantage Plan or Stand Alone Part D Plan during this period and the plan enrollment effective date will be January 1, 2012. There will be no changes allowed from December 8 – December 31, 2011.
You will receive up to a 50% discount on Part D covered brand-name drugs and a 7% discount on generic drugs purchased while in the gap (“donut hole”). The gap will be decreased over the years and will be closed by 2020.
A new annual Medicare Wellness Visit will be available. Many preventive services will be covered in full by Medicare starting in 2011.
The income threshold for Part B premiums paid by beneficiaries with higher income will be frozen from 2011-2019. Most people will pay $115.40 per month.
If you pay a higher Medicare Part B premium due to higher income, you will also pay a higher Medicare Part D plan premium. The additional premium will be withheld from your Social Security benefit; it does not go to your Part D plan.
The Nursing Home Compare feature on the Medicare.gov web site that allows you to compare information on every Medicare and Medicaid-certified nursing home in the country now contains expanded information.
A Physician Compare feature has been added to the Medicare.gov web site with information on physicians enrolled in the Medicare program and certain other eligible health care providers. Information on physician performance is required to be added to the Physician Compare feature by January 1, 2013.
Medicare Information Resources:
Senior LinkAge Line® 1-800-333-2433
Minnesota Board on Aging’s free statewide information and assistance service
www.mnaging.org/pdf/HCC2011.pdf
“Health Care Choices for Minnesotans on Medicare” booklet
Also available at many libraries and senior centers
1-800-MEDICARE (1-800-633-4227)
Official Medicare web site and phone number
Cindy Dubansky, MSW, LICSW, C-ASWCM is the President of Care Management Solutions, LLC, providing care management and health care advocacy services for seniors, people living with a disability or chronic illness and their families.
Care Management Solutions, LLC
PH: 612-308-0166. Email: info@caremanagementllc.com.
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Rev. February 2011
Copyright © 2011 Cindy Dubansky, MSW, LICSW, C-ASWCM. All Rights Reserved.
Friday, February 4, 2011
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