03 January 2011

Big Changes For Medicare Beneficiaries

Medicare beneficiaries to benefit from changes implemented this year:

Drug makers will provide a 50% discount on brand-name drugs and the government will provide a 7% discount on generics for consumers in the gap (Donut Hole).  Each year, the discounts will increase until the consumer's share of costs while in the gap is 25% for both name-brand and generic drugs.

The elimination of deductibles and coinsurance for preventative services, as recommended by the U.S. Preventive Services Task Force.

Coverage of annual wellness visit and personalized prevention plan at no charge.

Provides 10 % bonuses payments to primary care doctors working in areas with physician shortages.

Creates a CMS Innovation Center that will explore effective ways to create efficient payment systems that are patient-centered, and that preserve and provide incentive for high-quality care.

Reduces market basket updates for providers, beginning this year.  This stabilizes payments to the various Medicare providers, reducing changes and uncertainty regarding their payments for services from Medicare.

Prohibits private "Medicare Advantage" plans from charging enrollees more than Original Medicare for certain medical services, including chemotherapy administration and skilled nursing care.

Freezes "Medicare Advantage" plans payment rates to 2010 levels.  The intent is to reduce government subsidies to insurance companies by phasing in annual reforms intended to better match coverage costs in the private Medicare insurance market to those in the Original Medicare program.

Allows Medicare Advantage enrollees to switch to Original Medicare during the first 45 days of the new year.

Freezes inflation indexing for Medicare-related Part-B premiums for people with high incomes.

Raises drug plan premiums for individuals earning over $85, 000 and couples earning over $170,000.

Creates a new voluntary national insurance program for long-term care services (Community Living Assistance Services and Supports (CLASS) Program, financed through voluntary payroll deductions.  After five years of contributions one would be invested in the plan with an average lifetime benefit of $50.00 a day, depending on the needs of the person.

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