This is a critical time of the year for seniors, i.e. people 65 and older who are on Medicare. As most readers know, Medicare is the entitlement to medical services program for people 65 and older. Readers not in this category may have parents or friends who are Medicare recipients. Everyone with an interest in medical care services for seniors needs to be alert to the changes at hand.
There has been much nashing of teeth since the enactment of the Affordable Care Act (sometimes known as Obamacare). Whatever your views on this legislation, if you are directly affected, as all Medicare recipients are, these changes need your immediate attention.
1. Plan D - Drug Benefits. As many of you are aware, we are in the critical time of year for changes to Part D Drug Coverage. This is the time of year when many Plan D Insurers change benefits. One of these changes that can affect seniors is the change in "formulary", which is the list of drugs which is covered by the Plan. Drugs can either be added or deleted. These changes can cause confusion and perplexity. The advice right now: Talk to your Plan D Insurer or your Agent to find out what changes might be happening. Check the formulary for 2011 to see if it includes your drugs and what options you might have.
2. Doughnut Hole. The new law takes gradual steps to reduce the coverage gap known as the "doughnut hole." Those who reach the doughnut hole in 2010 may qualify for a one time $250 rebate check. A person reaching the "doughnut hole" in 2011 may get a 50% discount on brand name prescription drugs. Unless the law is changed, there will be a gradual closing of the "doughnut hole" through 2020.
3. Preventive Services. Those in original Medicare (not a Medicare Advantage Plan) will now qualify for a free yearly physical examination and other free preventive services. Your doctor will be aware of the services which will now be provided free under traditional Medicare. (Advantage Plans usually offered this service.)
4. Medicare Advantage Plans. As many seniors are aware, Medicare Advantage Plans were introduced in the last decade to provide medical services and drugs under separate plans administered by insurance companies. The administrators of these separate plans are principally Humana, United Health and the Blues. Among these companies there are literally dozens of plans that have been available with varying benefits, co-pays, exclusions and premiums. Many Medicare Advantage Plans included drug coverage at various levels.
You may be aware from the articles in the press that the 2010 Health Bill makes changes in Medicare Advantage Plans by reducing the subsidies to the insurance companies. As a result, there have been announcements by several insurers that they are either changing their Medicare Advantage Plans or discontinuing some of them. This is such a complicated area. We will not try to cover all the permutations and combinations. Seniors should refer to their 2011 handbook "Medicare & You," which is sent out by the government to all seniors. Medicare Advantage participants should consult their Agents and the reference book to see what changes might be in store for 2011. Decisions will need to be made before the first of the year, so "time's a wastin."
5. Part B Premium. The 2010 Affordable Care Act makes some changes in the Part B premiums to be effective in 2011. We are advised that the Part B premium will be affected by income, with higher income individuals having a larger amount deducted from their social security checks for Part B premiums. Check with social security at 1-800-772-1213, or the social security website to see if this change affects you.
6. Deadlines. As most seniors are aware, there are deadlines for making changes and elections. We are currently in the Part D enrollment period when changes in coverage can be made without penalty. Many seniors are also aware that there are penalties imposed for late elections and late changes.
7. Conclusion. This is a critical period for all Medicare Advantage participants, who include many of our clients. Blue Cross-Blue Shield has announced that they are terminating some of their Advantage Plans, while at the same time Humana and United Health are stepping up their recruiting. If you have an Advantage Plan, make sure what changes affect you. If you don't have an Advantage Plan, it may be that you will be able to enroll without penalty. Review the CMS 2011 booklet, Medicare & You.
Medicare services, benefits and costs are generally not within our professional competence. Our Elder Law work involves qualification for Medicaid (nursing home care), estate planning, guardianships and conservatorships. If you or your family have concerns in any of these matters, please contact Jim Modrall or Priscilla Hirt, or any of the attorneys listed below.
Donald A. Brandt, Joseph C. Fisher, Thomas R. Alward, Matthew D. Vermetten, Thomas A. Pezzetti, Jr., James R. Modrall III, Susan Jill Rice, Gary D. Popovits, H. Douglas Shepherd, Laura E. Garneau, David H. Rowe, or Nicole R. Graf at (231) 941-9660
BRANDT, FISHER, ALWARD & PEZZETTI, P.C.
This newsletter is provided for informational purposes and should not be acted upon without professional advice.
