Medicare: Big Changes for 2011

Every year, Medicare adjusts coverage parameters and guidelines for its enrollees.  In 2011, however, there are more changes than typical, most of which will provide benefits to many people across the country.

Recently everyone on Medicare’s mailing list received the yearly booklet Medicare & You. Just as in years past, most of us tentatively opened the cover to see how the changes for the upcoming year would negatively affect our health.

This year, however, was a pleasant surprise. The table of contents directs readers to page 12, "What You Need to Know in 2011." There is a list of the changes to expect in 2011. The ones that directly affect our health and wallets are:


o Part A and B premiums remain the same for most people

o More Preventive Services covered for less coinsurance

o New Yearly Wellness Exam offered

o Prescription Drug Coverage Gap (donut hole) rebate and additional help

Mostly your Part A and Part B Medicare premiums will be the same as in 2010.

Let’s begin with the Part A premiums, or What You Pay for Medicare. Directly from the Web site Part A: (Hospital Insurance) Premiums are:



"Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.·



The Part A premium is $248.00 per month for people having 30-39 quarters of Medicare-covered employment.·



The Part A premium is $450.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment."·

Bottom line is that most of us will not pay any Medicare Part A monthly premium.

For Part B, most of us will continue to pay the same amount we did in 2010. From the Medicare Web site it says: "Most beneficiaries will continue to pay the same $96.40 or $110.50 premium amount in 2011.  Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2011." 

Medicare has two booklets that further explain premiums and rates for people who have higher incomes than the amounts listed above. If you need these, please contact your local Social Security Administration office or call 1-800-772-1213. The titles are Will My Medicare Part B Premium Increase in 2011 and 2011 Part B Premium Amounts for Persons with Higher Income Levels. You can also see both of these booklets on the Web site.

Wellness Exam and Preventive Services

Next let’s talk about the New Yearly Wellness Exam and the Preventive Services charges. Beginning January 1, 2011, you will be able to have preventive services without paying anything, if you get those services from a participating, assignment accepting doctor or health care provider. However, you may have to pay the office visit coinsurance. Briefly, these preventive services are:

Abdonimal Aoritic Aneurysm Screening: A one-time ultrasound for people who are at risk for this condition.

Bone Mass or Density Measurement: Covered every 24 months to see if you are at risk for broken bones.

Cardiovascular Screenings: Blood tests to help detect risks for heart attack and stroke.

Colorectal Cancer Screenings: Help to find precancerous growths and detect cancer early for more effective treatment options. These include Fecal Occult Blood Test every 12 months; Flexible Sigmoidoscopy about every four years; Colonoscopy between two years and 10 years depending on risk factors and a Barium Enema between two and four years depending on risk factors.

Diabetes Screenings: If you have risk factors, up to two tests per year.

Diabetes Self-management Training: You pay 20 percent of the Medicare approved amount and the Part B deductible applies.

Flu Shots: Generally covered once per flu season.

Glaucoma Tests: Covered every year for people with a high risk.

Hepatitis B Shots: For people with medium to high risk and those with end stage renal disease.

HIV Screening: Covered for anyone who asks for the test.

Mammograms (screening): X-rays to check for women’s breast cancer are covered once a year.

Medical Nutrition Therapy Services: For people who have diabetes or kidney disease.

Pneumococcal Shot: Given only once it helps prevent certain infections such as pneumonia.

Pap Tests and Pelvic Exams (Includes Clinical Breast Exam): Checks for cervical, vaginal and breast cancers one every two years, or once a year for women with high risk.

Physical Exam: You get two…once when you first sign up for Medicare and one every year to help keep you healthy.

Prostate Cancer Screenings: A digital rectal exam and Prostate Specific Antigen test once a year.

Smoking Cessation: This is available even if you have not been diagnosed with a related illness or complication.

While the tests are covered under preventive services, in most cases you will have to pay the office visit coinsurance.

Drug Coverage Gap Changes, or Filling Up the Donut Hole

For as long as Medicare has attempted to help with prescription drug costs, there has been a break in the coverage. For most people, those not receiving "extra help," Medicare prescription drug plans follow this design. There is a monthly premium. There may or may not be a yearly deductible that you must meet before the drug coverage kicks in. You pay your copayment or coinsurance when you pick up a covered drug. You continue to pick up your prescriptions, paying your copayment or coinsurance, until you have paid $2,840 out of your own pocket towards your covered drugs.

Now here is the change…in the past, your prescription drug coverage ended from the time you paid $2,840 out of pocket until you had spent $4,550. In 2011, once you have spent the $2,840 out of pocket, you will get a $250 one-time check from Medicare to help with your prescription costs and you will be eligible to get covered brand-name drugs at 50 percent of their usual cost. Note that some Part D drug plans cover prescriptions without a break, however, these tend to have higher premiums.

For more details on selecting a prescription drug plan, see other articles on this Web site.

For more details on your Medicare coverage, see the Medicare & You booklet, go to the Medicare Web site or contact you local Social Security office at 1-800-772-1213.