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

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.)

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.)