The 2012 premium rates for Medicare Part B have been announced, and they will be lower than previously projected. For those whose 2010 income was less than $85,000, the monthly Part B premium will be $99.90 per month. For more info, go to www.medicare.gov.
Medicare has a program called “Extra Help” that can be a big savings for those who qualify. Medicare officials are estimating that approximately two million people qualify but have not applied. In order to get the benefit, one must apply. If eligible, the prescription savings can be significant.
Under the Extra help program, one qualifies with an income below $16,335 (single), or
$22,065 (married). Additionally, resources (excluding one’s home, cars and personal possessions) must be worth no more than $12,640 (single), or $25,260 (married).
Once enrolled, the savings are in the premiums, deductibles and low copayments for
drugs. If you know someone struggling with the cost of their medications, qualify on income, and they are enrolled in a Medicare Part D prescription plan, they can enroll online at the Social Security Website or call 1-800-772-1213.
As a Geriatric Care Manager and Elder Care Consultant, I am often asked to help sort through the details of Medicare coverage. There are so many things to know and to understand: Parts A & B, Medicare Advantage (Part C) and Part D for prescription coverage. Earlier in 2011 we began to see the changes under the new health care law. One of those changes turns out to have been a little confusing. Here is why:
Beginning in 2011, Medicare started covering an annual physical exam, or so many thought. But, as it happens, it wasn’t really a physical exam in the true sense. What Medicare started covering is a “Wellness Visit,” which is definitely different than a physical exam.
The 2011 Medicare Handbook “Medicare and You 2011” labeled it a “physical exam.” Logically, many Medicare recipients expected a physical exam. But a wellness visit is less a physical exam and more of a discussion between a doctor and patient, reviewing a patient’s health status and medical risk factors. The discussion may lead to referrals to specialists or for further tests.
Because of the misleading information in the 2011 handbook, the 2012 handbook is being updated to reflect the true “Wellness Visit.” It is also recommended that Medicare recipients specifically request a “wellness visit,” if that is what they are seeking. It is an annual wellness visit that Medicare will cover. A physical exam is altogether different, and coverage for it is as well.
Kathleen S. Allen, LCSW, LICSW, C-ASWCM, is a Geriatric Care Manager and Elder Care Consultant in the Washington D.C. metropolitan area. She works with seniors and their families, and with organizations and their employees or members to help guide them through the challenges of aging and caregiving.
Medicare Open Enrollment is upon us, and for those with Parts C (Medicare Advantage) or Part D (Prescription Coverage), this is the time to review your current plan for changes, and if necessary, find an alternative that fits your medical and financial needs.
Some good news this year is that the premiums for Part D plans are holding steady, and the 50% brand drug discount will continue through 2012. There will also be a 14%
generic drug discount in 2012. That means that when you are in the coverage gap for your medications, and you need to buy a brand name drug, the cost to you will only be 50% of the total cost, but the full cost of the drug will count toward your total out of pocket
expense. Similarly, generic drugs will have a 14% discount during the coverage gap in 2012 but the total cost will apply toward your out of pocket costs.
When we talk of Part D plans, out of pocket expenses, and premiums and deductibles, it is easy to get confused. An excellent online resource for calculating out of pocket prescription expenses can be found at Q1Medicare. If you plug your drug costs in, it will calculate when you reach the coverage gap (also known as the “doughnut hole”), when you exit, and estimate your total out of pocket expenses for the year. A picture is worth a thousand words, as they say, and the table that shows on the calculator sometimes explains things far more effectively than an article explanation.
A word to the wise: Please proceed with this process earlier rather than later. Past years have shown that the Medicare phone lines get very busy in the final days and the website can slow down when so many people are on it at once.
Social Security Administration: ssa.gov, or call 1-800-772-1213.
Centers for Medicare and Medicaid Services (CMS): medicare.gov or call 1-800-633-4227. The medicare.gov website has a resource locator to help you find a doctor, compare hospitals, check coverage, get information on Medicare coverage, and compare Medicare options and plans. The “Medicare and You” handbook is also available on this site.
State Health Insurance Assistance Programs: each state has such a program, which provides trained counselors to help on all Medicare and Medicaid issues. This service is free. To locate your SHIP office, call 1-800-677-1116 or go to shiptalk.org.
Part D Prescription Drug Plans are offered through private insurance companies, or as part of Medicare Advantage plans. If you are enrolling in Medicare Part A or B, and need prescription coverage because you do not have coverage through another source, you can enroll in a Part D drug plan. There is a separate monthly premium amount payable to the insurer you sign up with, and the premium, covered medications and co-pays are all plan specific. A good way to start comparing drug plans in your area is to go to https://www.medicare.gov/find-a-plan/questions/home.aspx and enter your zip code and drug info. The site will generate a list of possible plans in your area and you will be able to see premiums, co-pays, annual out of pocket costs. When in doubt, or if you need more info, you can call the plans directly to get more specifics. Enrolling in a part D plan can be done through Medicare, or directly with the plan you choose.