Monday, November 29, 2010

Medicare Preventive Services in 2011: A New Service and Changes in Cost Sharing

You need to start planning your 2011 preventive services now to take full advantage of changes to Medicare which have come about in the health reform legislation.

The most significant change in Part B will be the introduction of an annual “wellness exam” and the elimination of applying the annual deductible or paying coinsurance for many preventive services. If your provider accepts assignment for these services, you will pay nothing for them. But not all preventive services are included.

The new Annual Wellness Exam is a physical exam which includes a “comprehensive health risk assessment” and a “personalized prevention plan.” The personalized prevention plan takes into account the findings of the health risk assessment and include elements such as: a five- to ten-year screening schedule; a list of identified risk factors and conditions and a strategy to address them; health advice and referral to education and preventive counseling community-based interventions to address modifiable risk factors such as physical activity, smoking, and nutrition. No coinsurance or deductible will apply to this newly covered service.

You can get this exam once every 12 months, but not within first 12 months of Part B enrollment (which is the timeframe in which you can get the “Welcome to Medicare” physical exam). And, because is it very similar, you can‘t get it within 12 months of a “Welcome to Medicare” exam.

Most beneficiaries should immediately schedule one of these exams for 2011 with their physician, as, unless they meet either of the two exceptions above, the sooner they get it, the sooner they can get it in subsequent years. Plus my experience is that it often takes a good deal of time to schedule a physical, so call now for your first date in 2011.


These are the preventive services which, beginning in 2011, will not be subject to the Part B deductible or coinsurance:

“Welcome to Medicare” Physical Exam
Annual Wellness Exam
Abdominal Aortic Screening
Bone Mass Measurement
Flexible Sigmoidoscopy
Colonoscopy
Pelvic Exam and Clinical Breast Exam
Screening Mammogram
Tobacco Cessation Services
Medical Nutrition Therapy Services
Hepatitis B Shot

If you have not gotten these and you are otherwise eligible (the criteria are spelled out in Chapter 4 of Managing Your Medicare) you should take this opportunity to make an appointment in 2011 to get the service.


Note that these preventive services already had no cost sharing, and if you need them, get them right way, don’t wait ‘til 2011:

Cardiovascular Disease Screening (lab test)
Fecal Occult Blood Test (lab test)
Diabetes Screening (lab test)
HIV Screening (lab test)
Pap Smear (lab test)
PSA (lab test)
Flu Shot (including the “swine” flu (H1N1) shot)
Pneumococcal Pneumonia Shot

(Note that lab tests have to be assigned and are not subject to the deductible or coinsurance, but you may have to pay part of the cost of the visit to take the specimen or have the results interpreted.)


These preventive services will continue, in 2011 and beyond, to have the deductible and coinsurance apply, as before, so there is no sense in waiting to avail yourself of them:

Barium Enema
Glaucoma Screening
Digital Rectal Exam
Kidney Disease Education (KDE) Services

Sunday, November 28, 2010

Elimination of the Open Enrollment Period and Inauguration of the Annual Disenrollment Period

In 2011 the Medicare Advantage Open Enrollment Period, which has run from January 1 to March 31 and which allowed you to make a variety of changes to how you got your Medicare, and which Plan you were in, is eliminated. It will no longer be in effect.

In its place is a new Annual Disenrollment Period, which will run only from January 1 to February 14 of 2011 and every year thereafter. It is important to understand that this new period is less than half as long as the previous one, so you will have to act more quickly to make any permissible changes.

The changes you can make during this 45-day period are these: (Note that they are much more restrictive than what you could do in the now obsolete Medicare Advantage Open Enrollment Period.)

You may leave Medicare Advantage (Part C) and go to Original (fee-for-service) Medicare. The change will be effective first day of month following the date you disenroll from your Medicare Advantage Plan.

And, if you do so, you may join a stand-alone Part D drug plan. You will join this drug plan on first day of month following the date the plan gets your enrollment request. Note that you may enroll in a Part D plan whether or not the Medicare Advantage Plan you were in did or did not have Part D drug coverage.

And you do this either by:

Disenrolling from your Medicare Advantage Plan. This will put you in Original Medicare without any Part D drug coverage.

Or by enrolling in a stand-alone Part D drug plan. This will automatically disenroll you from your Medicare Advantage Plan and put you into Original Medicare and enroll you in the Part D drug plan.

And you may disenroll from your Medicare Advantage Plan and later enroll in a stand-alone Part D drug plan, as long as you enroll by February 14, 2011.

You may NOT join a Medicare Advantage Plan nor switch from one Medicare Advantage Plan to another.

And just to forewarn you, as this is critically important, the “Annual Election Period,” which has run from November 15 to December 31 of each year, will change in the fall of 2011 for enrollments to be effective January 1, 2012. In 2011, this period will begin on October 15 and end on December 7. So be prepared, earlier next fall than you are used to, to figuring out the best Medicare Advantage Plan for you. (This also affects Part D, whether you get it through your Medicare Advantage Plan or a stand-alone Part D plan.)

Monday, November 22, 2010

The Triple (or Quadruple) Whammy!

Some of you are probably getting notices now about how much your Medicare Part B premium will be in 2011. For most beneficiaries, they won’t change because their Social Security payments won’t go up. But for those of you who don’t have it taken out of your Social Security or Railroad Retirement payment, or who are subject to the Part B high income premium surcharge, you will see an increase, to $115.40. And those of you who are subject to that surcharge (it’s between $46.10 and $253.70 per person per month – see the blog I posted 11/15/10), you get the double whammy of the increased rate PLUS the surcharge! But wait, it’s really worse – the increase in the basic Part B premium from $110.50 to $115.40 is partly due to the fact that someone has to make up the difference stemming from the situation that about three-quarters of Part B beneficiaries are paying a reduced rate (most of them $96.40) and SOMEONE has to make up difference, and that someone is you. (And, ironically, state governments who are subsidizing the Part B premiums of less well-to-do beneficiaries.) So if you feel a little burdened, it’s because you are!

Oh, and the quadruple whammy? If you are subject to the Part B high income surcharge and you also have Part D, in 2011 you will also pay a high income surcharge for your Part D prescription drug benefit. But not to worry, the surcharge is much less than Part B’s. It runs from $12.00 to $69.10 per person per month. (My posting of 10/04/10 has the details.)

Friday, November 19, 2010

2011 Extra Help Resource Limits

The Centers for Medicare & Medicaid Services (CMS) has just released the resource limits which will be in effect in 2011 for Medicare beneficiaries to receive “extra help” with their Part D prescription drug benefit. This is also known as the “low-income subsidy” (LIS). The resource limits for 2011 are:

For the full low-income income subsidy, resources may not exceed:
$8,180 for an individual or $13,020 for a married couple.

For the other (partial) low-income income subsidy, resources may not exceed:
$12,640 for an individual or $25,260 for a married couple.

(For 2010, these limits are:

For the full low-income income subsidy, resources may not exceed:
$8,100 for an individual or $12,910 for a married couple.

For the other (partial) low-income income subsidy, resources may not exceed:
$12,510 for an individual or $25,010 for a married couple.)

(Note that all of these limits include the $1,500 per person burial expense “disregard.” That is, these are the limits which apply if the beneficiary intends to use $1,500 ($3,000 for a couple) of their resources toward their burial expenses.)

Also note that at this point the income limits will remain as they have been in effect for 2009 and 2010. They may be changed if there is a change in the federal poverty levels (FPL); typically this is announced in January of each year. Those who have had their extra help determined using the current income limits will NOT have their limits recalculated, rather only new applicants for extra help will be subject to the 2011 income limits, if they change.

Sunday, November 14, 2010

2011 Medicare Premiums and Deductibles

Medicare has finally released the rates for 2011; for some reason it waited until after Election Day to do so, even though the increases are relatively modest.

Premiums:

The Part B premium will increase from $110.50 to $115.40, or only 4.4%.

However, most people will not pay this much because there will be no increase in Social Security payments in 2011, and the “savings clause” that prevents, when this situation occurs, any rise in Part B premiums for those who have them deducted from their Social Security payments will continue in effect.

For those of you who are paying $96.40 because this same savings clause prevented an increase to your Part B premium in 2010 will continue to pay the same $96.40 in 2011.

For those of you who began having your Part B premiums deducted from your Social Security in 2010, and who are paying $110.50 a month, you will continue to pay this same $110.50 in 2011.

For those of you who will be going on Medicare in 2011, and for those of you who do not get your Part B premium deducted from your Social Security, you will pay the $115.40. The exception is that if you are subject to the Part B high income premium surcharge, you will pay the $115.40 plus the surcharge. That information is included at the end of this blog.

Note that the savings clause also applies to those who have their premium deducted from their Railroad Retirement payments, but not for those who have it deducted from their Civil Service annuity payments.


For those few beneficiaries who pay a monthly premium for their Part A, your premium will decrease to $450.00 from $461.00 for those of you who have less than 30 quarters of Social Security coverage, and will decrease to $248.00 from $254.00 for those of you who have at least 30 quarters of coverage. I do not recall a time when this decreased!

Deductibles:

The Part B deductible will increase to $162.00 for 2011 from $155.00 in 2010, or $7.00.

The Part A inpatient deductible will increase to $1,132.00. The inpatient coinsurance for days 61-90 of an inpatient stay will go to $283.00 per day (one-quarter of the deductible) and the coinsurance for lifetime reserve days (days 91 to 150 of an inpatient stay) will go to $566 (one-half the deductible). These amounts are, in 2010, $1,100.00, $275.00 and $550.00 respectively.)

For stays in a Skilled Nursing Facility, the coinsurance for days 21 to 100 will go to $141.50 per day (one-eighth the deductible). (This is $137.50 in 2010.)


The Part B high income premium surcharges will be as follows. Note that “MAGI” is your “modified adjusted gross income” reported on your 2009 federal income tax return. It is the sum of your adjusted gross income plus any interest-free income. Page 20 of Managing Your Medicare explains this in depth. (Medicare calls these "income related monthly adjustment amounts" or "IRMAAs.")

If you were single and had a MAGI over $85,000 but less than $107,000, or if you were a couple filing jointly with an MAGI of over $170,000 but less than $214,000, your monthly Part B premium will be $161.50 a month, or a surcharge of $46.10 a month.

If you were single and had a MAGI over $107,000 but less than $160,000, or if you were a couple filing jointly with an MAGI of over $214,000 but less than $320,000, your monthly Part B premium will be $230.70 a month, or a surcharge of $115.30 a month.

If you were single and had a MAGI over $160,000 but less than $214,000, or if you were a couple filing jointly with an MAGI of over $320,000 but less than $428,000, your monthly Part B premium will be $299.90 a month, or a surcharge of $184.50 a month.

If you were single and had a MAGI over $214,000, or if you were a couple filing jointly with an MAGI of over $428,000, your monthly Part B premium will be $369.10 a month, or a surcharge of $253.70 a month.

If you were married and living together, but file separately, and had a MAGI of over $85,000 but less than 129,000, your monthly Part B premium will be $299.90 a month, or a surcharge of $184.50 a month.

If you were married and living together, but file separately, and had a MAGI of over $129,000, your monthly Part B premium will be $369.10 a month, or a surcharge of $253.70 a month.

Note that the surcharges are calculated as if you would normally be paying $115.40 a month, the standard Part B premium for 2011, but, of course, you may have otherwise qualified for the $96.40 or the $110.50 under the “savings clause” provision discussed above, in which case your true monthly surcharge is either $19.00 or $4.90, respectively, more than shown above.

Pages 20-21 of Managing Your Medicare explains how to appeal to Social Security if they use the wrong income, or if your circumstances have changed significantly since you filed your 2009 income tax (perhaps you retired, your business burned down, you divorced, or your spouse died, etc.).

My blog of 10/04/10, “2011 High Income Part D Premium Surcharges,” tells you what your surcharges will be if you are in Part D in 2011.
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