Two cost-free benefits for Medicare recipients aimed at helping them stay healthier were recently announced by the Centers for Medicare and Medicaid Services (CMS).

 Flu shots: Medicare and health plans will be offerings flu shots without co-pays or deductibles this year thanks to the Affordable Care Act.  Doctors highly recommend flu shots for all (except those with allergies or certain health conditiions).  No word yet on what flu strains we can expect to see this year, but officials say there should be enough vaccine.  For those over 65, there is a new high-potency vaccine available to see if it offers better protections for those with aging immune systems. 

Ann Schuchat, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, says no one can predict how the year will turn out, partly because no obvious pattern surfaced during winter flu season in the Southern Hemisphere, according to USA Today.

One of the three strains now circulating in the USA is H3N2, a variety often linked to more serious disease and death. “H3N2 hasn’t really hit the U.S. in large numbers yet. We do think most people will be susceptible to this,” Schuchat says.

 Smoking cessation classes:  the benefit will be available to all smokers, regardless of whether they have been diagnosed with a tobacco-related illness, or show symptoms of such an illness, as long as they “are competent and alert at the time the counseling is provided.” The counseling must be provided by a Medicare-qualified physician or other practitioner. Medicare will pay for two counseling attempts consisting of four sessions, for up to eight individual sessions per year for each qualified beneficiary. All Medicare beneficiaries will continue to have access to smoking-cessation prescription medication through the Medicare Prescription Drug Program (Part D). 

 Despite the expansive list of adverse effects caused by tobacco use, and smoking in particular, about 46 million Americans continue to smoke.  Of these, an estimated 4.5 million are Medicare beneficiaries 65 or older and less than 1 million are younger than 65 and are covered by Medicare due to a disability.   For smokers who successfully quit, the health benefits will begin immediately and continue for the rest of their lives.  These benefits include reducing their risk of death from coronary heart disease, chronic obstructive lung disease, and lung and other cancers. 

Previously the counseling was only available to those who had been diagnosed with or who showed symptoms of a tobacco-related disease.

Some good news for Medicare beneficiaries…your rates for Part D Prescription Drug insurance should be pretty much the same in 2011 as in 2010. 

The average monthly premium will be about $30 compared to $29 in 2010. 

Of course averages are just that averages – so some people will see smaller increases while others may see their rates increase more.  It all depends on your plan which is why it’s smart to shop and compare your current plan to the new plans when the information comes out in October, 2010. 

CMS (The Centers for Medicare and Medicaid Services) has not yet released information on  Medicare Advantage plan rates for 2011.  There has been speculation that those plans could see significant changes in rates and/or benefits, but we’ll have to wait and see. 

The monthly Part D premium should not be the only driver in your decision on which plan to choose.  Watch for changes in the formulary (drug list) which tells how much you will pay out-of-pocket for your medications.  Plans may shift drugs between tiers which can increase or decrease your co-pay( out-of-pocket rates). Also if you’ve changed the  medications you use regularly, you’ll want to see if your current plan is still the right plan when you consider both the premium and out-of-pocket costs. 

As a reminder for those who currently have a Part D or Medicare Advantage plan.  Changes to these plans can generally be made only during the Annual Enrollment Period (AEP) from Nov. 15 – Dec. 31 in 2010 for plans effective in 2011.  Here’s the schedule leading up to AEP: 

September –Information about premium and benefits for each Part D and Medicare Advantage plan becomes available

October – More detailed plan information is available so that you can begin comparing plans

Nov. 15- Dec. 31 – applications for plans effective in 2011 can be accepted 

So make sure to mark your calendar for early to mid-October to start comparing plans.  while you can’t buy until November, you’ll give yourself some time to compare plans and think about the right plan for 2011.

Here’s the statement from Medicare on part D premiums for 2011.  

“Most Medicare prescription drug plan premiums should remain relatively stable next year, and all beneficiaries should compare their coverage under their current plan with the plans that will be offered in 2011 when that information becomes available in October,” said Jonathan Blum, deputy administrator of CMS’ Center for Medicare. “The Affordable Care Act improves the value of drug coverage people with Medicare will receive next year, providing discounts on brand name drugs and coverage of generics in the coverage gap, or donut hole.”

The New York Times blog “Bucks” just ran a great 3-part series of questions and answers about Medicare.   

You can find them here.

The expert answers were provided by the Medicare Rights Center and cover the basics to some very specific questions about benefits and coverage for the disabled. 

Whether you are new to Medicare or a Medicare beneficiary who has questions about coverage or getting ready for the annual election period (AEP), you’ll find the information helpful. 

If you like to plan ahead, the AEP is Nov. 15 – Dec. 31, 2010 for policies that will be effective in 2011.  For most of those with Medicare Advantage plans and Medicare Part D plans this is the one time of the year when you can change your coverage (there are some exceptions like if you move or your employer retiree insurance is cancelled). 

Experts say that comparing your current Medicare plan to other plans may be especially important this year as some plans could see major changes in prices and benefits.  It’s a good idea anyway to check your plan each year if you buy your own policy to make sure the rate is competitive and the polilcy still fits your health care needs.

Plan information and prices for policies effective in 2011 aren’t available yet.  You’ll have to wait until October. 

 But if you’ve got general questions, now is the time to start reading up on Medicare.  Or post them here and we’ll help you find the answers.

 Medicare and Social Security are in pretty good shape according to the 2010 Annual Report of the Trustees.  That’s good news for all of us.  But especially those who are retired or close to retirement and counting on specific benefits from both programs. 

The report said that Medicare is looking much healthier, thanks to the changes in the health care reform bill that reduces costs for prescription drugs and physician services..  The Hospital Insurance trust fund is expected to remain solvent an additional 12 years – until 2029.  While Medicare finances have improved, further reforms will be needed. 

It is not quite so rosy a picture for Social Security, but there’s no reason for alarm.  The recession created a double-whammy of fewer workers and more early retirees.  So Social Security expenditures are expected to exceed tax receipts in 2010 for the first time since 1983.  Read the full report here. 

 “The fact that the costs for the program will likely exceed tax revenue this year is not a cause for panic but it does send a strong message that it’s time for us to make the tough choices that we know we need to make,”  said Michael J. Astrue, Commissioner of Social Security. 

The report said that the deficit is expected to shrink substantially for 2011 and to return to small surpluses for years 2012-2014 due to the improving economy.   But as the baby boomers begin retiring in larger numbers in 2014 the number of beneficiaries grows substantially more rapidly than the number of covered workers. That’s the problem we’ve been talking about for years – too few workers to support the number of retirees.

So for those nearing retirement, counting on Social Security at current levels sounds pretty safe.  But, the changes will continue to come in Medicare to keep the program financially sounds.  That means it will be more important than ever to review your Medicare insurance plan each year. Expect that to be particularly true for Medicare Advantage and Medicare Part D plans.

Both Medicare and Social Security have turned to familiar faces to tell their story.

 Andy Griffith, Patty Duke, Chubby Checkers.  You know the faces…and the songs!

As part of the recognition of the 45^th anniversary of Medicare,  a new public service announcement was released by the Centers for Medicare and Medicaid Services (CMS) staring Andy Griffith.  You likely remember him from The Andy Griffith Show and Matlock.   

The commercial highlights the new services Medicare beneficiaries will receive thanks to health care reform including free checkups, lower prescription drug costs and continuing crack down on Medicare fraud.

Here’s a link to the Andy Griffith Medicare public service announcement.

 The new advertisement will begin running immediately on national cable television stations.  The advertisement is part of CMS’ efforts to educate and inform people with Medicare and their family members about the many changes and improvements to the program’s various options in advance of Medicare Open Enrollment. 

A new report from CMS reports that savings to Medicare will rise to more than $575 billion over the next decade.  These reforms include new provisions that will improve the quality of care, develop and promote new models of care delivery, appropriately price services, modernize the health system, and fight waste, fraud, and abuse.  The Affordable Care Act is projected to more than double the life of the Medicare Trust Fund, extending its life from 2017 to 2029. 

Social Security has been using celebrities to draw attention to signing up for Social Security online.  For many people, a long wait at the Social Security is no longer necessary to sign up for Social Security benefits.  When it launched the Patty Duke commercial in 2009, Internet application jumped 9% in the next 30 days.   Click here to find the video of Patty and Chubby

There’s something comforting about seeing those familiar faces delivering important messages about Social Security and Medicare.  And I find myself humming those opening tunes for their old TV shows – funny what gets locked away in the brain? 

What do you think about celebrities in public service announcements for Medicare and Social Security?

Knowing how your health insurance works and what your part of any medical cost will be is important at any age.  But once you are living on a fixed income, understanding what Medicare covers and what you have to pay at a doctor’s office or at the hospital or for prescription drugs is critical. Your budget depends upon it!

When it comes to figuring out Medicare coverage understanding the difference between a co-pay and co-insurance is a good place to start.  This article from the New York Times has some helpful information, especially when it comes to employer plans. You might want to pass it along to someone figuring out their workplace health insurance.

The same basic concepts apply in Medicare – but how they apply to different types of plans is important to know. So let’s take a look at the basics in figuring out your cost of care: co-insurance, co-payment and deductible (we’ll cover insurance premiums in a later post.)

Deductible is the amount you must pay for health care or prescriptions, before Original Medicare, your prescription drug plan, or other insurance begins to pay. For example, in Original Medicare, you pay a new deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year.

Co-insuranceis the amount you may be required to pay for services after you pay any plan deductibles.  In Original Medicare, this is a percentage (like 20%) of the Medicare approved amount. You have to pay this amount after you pay the deductible for Part A and/or Part B. In a Medicare Part D Prescription Drug Plan, the coinsurance will vary depending on how much you have spent (the doughnut hole issue.) so, if the procedure is $100, Medicare pays $80 and you must pay $20.

Co-payment (co-pay) on the other hand is the amount you pay for each medical service, like a doctor’s visit, or prescription. You’ll find this most frequently in Medicare Advantage plans and Medicare Part D plans. A co-payment is usually a set amount you pay. For example, this could be $10 or $20 for a doctor’s visit or prescription. Co-payments are also used for some hospital outpatient services in Original Medicare.

Also, Medicare doesn’t cover everything.  That surprises a lot of people …often at a critical time of need when they find that the cost of care is theirs alone.  For example, generally long-term care is not covered.  So, for example, Medicare may cover rehabilitation services following a stroke, but once the person is ready to go home, they will pay for their own care.

So how does all this fit together when you are trying to decide among Medicare Advantage, Medicare Supplement and Part D prescription drug coverage?

Here are a couple rules of thumb as you consider different Medicare plans:

Medicare supplement insurance covers the gap (that’s why it’s called Medigap insurance) in Medicare Part A and Part B coverage – the 20% of cost that Medicare doesn’t cover, some plans cover the Part B deductible, provide additional days of coverage beyond what Medicare provides.  A good way  to think about medigap insurance is that it pays only when Medicare pays. You generally won’t find co-pays in these plans.  But, two new plans: Plan M and Plan N do have co-pays – so calculate in those costs if you consider these Medigap plans. All Medigap plans are standardized which means all insurance companies offering the plans must offer the same benefits.  But prices can vary, so compare plans before you buy.

Medicare Advantage (Medicare Part C): These plans wrap Medicare Part A and Part B together – sometimes includePart D and sometimes additional benefits like vision or dental.  Cost sharing in these plans takes all types of forms.  It depends on the individual plan.  So ask lots of questions and make sure you understand deductibles, co-insurance, and co-payments.

Part D prescription drug plans vary widely.  So look closely for deductibles, co-payments, co-insurance and the coverage gap (donut hole).

So when you shop and compare Medicare plans make sure you fully understand your cost of care:  know the deductibles, co-pays and co-insurance of any plan you are considering so you won’t be surprised when the bill comes due.

Resources:

Medicare and You 2010  Government resource

What’s New About Medicare Supplement Plans from Longevity Alliance

 If you have Part D prescription drug plan and have reached the dreaded “donut hole” where you begin paying the full cost for your medication, your $250 rebate check is in the mail.   

The U.S. Department of Health and Human Services (HHS) is expected to begin mailing the checks this week.  Checks are mailed automatically since Medicare tracks your drug costs.  There is no request that has to be made – so watch out for scam calls or mailings that say you need to provide your Medicare information to receive a check.  Checks are being sent to the address Social Security uses to reach you.

 Here’s a new brochure on the $250 rebate plan that may answer additional questions. 

A new round of checks gets mailed each month, as a new group of people enter the “donut hole.”  An estimated 3 million people per year reach the donut hole.  The $250 rebate is intended to help offset part of their drug expenses.

 One way to reduce your costs of prescriptions is to make sure you have a Part D plan that matches your needs.  Each year the government has an “open enrollment” period where you can shop, compare and change plans if your health care or prescription needs have changed.  That period is Nov. 15-Dec. 31 and you can usually begin getting price information for the new plans in mid-October.  So mark your calendar

Medicare beneficiaries will soon be receiving  “Medicare and the New Health Law – What it Means for You” in their mailboxes. The mailing from the Centers for Medicare and Medicaid (CMS) outlines key provisions of the Affordable Care Act for people with Medicare as well as members of their families.

And there’s a new web chat from Medicare about topics covered in the brochure, such as the $250 rebate.  You’ll find it here on YouTube.

The brochure provides highlights, not a lot of detail, but is helpful in sorting through the myth and reality of what impact health care reform has on Medicare beneficiaries.

The first benefit that many people with Medicare will receive as a result of the passage of the new law is a one-time check for $250.  In order to qualify for the $250 check they must be Part D policy holders who enter the Part D donut hole and are not eligible for Medicare Extra Help.  More information on this one-time fee at this MomentumToday article.

Beginning next year, the Affordable Care Act ensures that Medicare beneficiaries will get free preventive care services like colorectal cancer screening and mammograms, in addition to a free annual wellness visit. The law also includes new tools to help fight fraud by helping Medicare crack down on criminals who are seeking to scam seniors and steal taxpayer dollars.

The mailing encourages beneficiaries and their family members to log on to http://www.medicare.gov  or call 1-800-MEDICARE to get their questions about Medicare or the Affordable Care Act answered and reminds them to be on the alert for possible scams.

The brochure is available in both English and Spanish.

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf English version

http://www.medicare.gov/Publications/Pubs/pdf/11467_S.pdf Spamish version

If you are a Medicare beneficiary and have a chronic medical condition that requires a brand name drug you’ve probably seen the price of that drug rise dramatically in the past year.  A new report from AARP confirms that brand name drug prices are rising faster than than prices on other goods and services we buy.

AARP estimates that for the past 12 month period there has been a 9.7% jump in manufacturer prices for brand name drugs widely used by people on Medicare. At the same time, general inflation has been flat.

That’s one of the reasons that people with Part D Medicare Prescription Drug coverage find themselves entering the “doughnut hole” this time of year where they begin paying the full cost of their drugs.  Those who take specialty drugs – which can cost between $1000 to $20,000 per month have seen prices increase 9.2% in the same time period.

The only bright spot in drug pricing has been generic drugs where prices have dropped 9.7% for medications widely used by those in Medicare.  The average annual costs of therapy for someone taking three generic drugs decreased $51 compared to the $706 increase by a person taking three brand name prescriptions.  Here’s the full AARP report.

It’s a good reminder to talk with your doctor about whether or not the drug being prescribed is available in generic form.  It could mean thousands of dollars per year in savings. 

And if you are turning 65 and deciding whether to purchase prescription drug coverage, it’s a good reminder of how much of a bite medication can take out of your budget.  As you shop for Medicare coverage, remember that a Medicare supplement plan does not provide drug coverage.  You’ll need to purchase a separate Part D policy.  If you are considering a Medicare Advantage plan, find out whether or not it includes coverage for prescription drugs.

 Longevity Alliance provides more tips on how to cut health care costs in this brochure.

It’s the kind of research about Medicare and aging that makes you scratch your head.  Yet the finding is critical to retirement planning and estimating your costs for Medicare and long-term care. 

Healthy retirees actually face higher total health care costs over their remaining lifetime than the unhealthy, according to new research conducted by the Center for Retirement Research (CRR) at Boston College and underwritten by Prudential Financial.

So before you run out for ice cream, beer, steak – whatever else you’ve dropped from your diet to stay healthy – think about why the costs are higher. They are pretty compelling reasons to keep up with the healthy lifestyle. but also plan for the increased costs of a longer life.

The Center for Retirement Research study cites reasons the healthy incur higher lifetime health care costs than the sick:

1.  People in good health can expect to live significantly longer, and therefore are at risk of incurring health care costs over more years.

2.  Many of those currently free of chronic disease will succumb to one or more such diseases.

3.  People in healthy households face an even higher lifetime risk of requiring nursing home and other long-term care than those who are not healthy, reflecting their greater risk of surviving to advanced old age, when the risk of requiring such care is greatest.

So, the good news is if you are healthy you’ll probably live longer.  And, the reality is that as the years go by a chronic medical condition will increase your health care costs and make it more likely that you will need long-term care assistance.  

For example, an 80 year old can expect to spend one-third of their remaining life suffering from one or more chronic diseases.  That will likely lead to higher out-of-pocket expenses and long-term care costs.

So what do you do with this information?  The key message is don’t put off purchasing insurance – like Medigap insurance or long-term care insurance – because you are healthy today. 

It’s an easy trap to fall into.  Feeling so good about your health today, it’s hard to think about a time when you are older and not so healthy.  So you put off the decision to purchase insurance.  But, then you discover that you can’t buy the insurance when you need it – that’s the nature of insurance.  Insurance is about protecting yourself from future risk that may or may not happen.

The researchers put it this way: “Individuals who wait until their health declines represent a particularly bad risk because they incur higher medical costs than the healthy, at least in the short run, and also pay fewer years’ premiums.  Therefore, households that do not buy Medigap when they first join Medicare run the risk of facing substantially higher premiums, as do household of any age that postpone buying long-term care insurance.”

So if you’ve been putting off purchasing Medigap or long-term care insurance because you are healthy now.  This research is a new way to look into the crystal ball of the future  – and the likelihood of needing health care should send you Medigap and long-tem care insurance shopping. 

Resources: 

“Does Staying Healthy Reduce Your Lifetime Health Care Costs” Center for Retirement Research at Boston College  

How to Cut Health Care Costs from Longevity Alliance