Peninsula Daily News for 1-6-11 "Some Medicare Updates"

Welcome to the first Thursday of 2011! Presumably (Hopefully!), most of us are “holiday survivors,” and with the exception of the odd leftover or fugitive piece of wrapping paper, are moving on to the new year; thus, if you happen to live in my world (which I almost always do), what do you need to know? Well:

• In case you missed it, somehow, Congress and the President managed to delay, once again, a 25 percent cut in Medicare reimbursements to doctors for one year. We look forward to replaying this traditional holiday crisis later this year;
• The traditional holiday crisis that we WON’T have to look forward to later this year is the Part D and Medicare Advantage Plan “annual election period” (think, “open enrollment”) running from November 15 through December 31^st, effectively nullifying any possibility of holiday joy. This year, it will run from October 15^th through December 7^th, sparing Christmas while sacrificing Halloween;
• Beginning last Saturday (January 1, 2011) and running through February 14^th, anyone with an Advantage Plan who wants to get out, can; specifically, you can move to “original” Medicare and will be allowed to pick up a Part D plan for drug coverage. You cannot switch from one Advantage Plan to another, nor can you join one, but you can disenroll; remember, any changes you make will take effect on the first day of the following month;
• Did I mention Part D? OK, this year, if you’re unfortunate enough to hit the “donut hole,” you’ll get discounts of 50% off brand-name drugs and 7% off generics. This replaces last year’s $250 windfall, so you will NOT get another $250 in 2011. And remember, if you receive the “low income subsidy” (“LIS,” also known as “extra help”), you have no donut hole. More on this later. And if you have no idea what the “donut hole” is, good for you! Forget the whole thing and go have a Danish;
• If you slept through the last half of 2010, you’ve probably figured out by now that there was no Social Security “COLA,” which puts a lid on the Part B premium, so what does that mean? Well, if you were on Medicare before 2010, your Part B premium will stay the same: $96.40 per month. If you joined up in 2010, your Part B premium will continue to be $110.50, and if you plan on enrolling in 2011, you can anticipate a premium of $115.40. If your annual income is more than $85,000 for a single person or $170,000 for a couple, you can expect to pay (or already are paying) more, and you’ll get socked with a higher Part D premium, too. Glutton for punishment? Want to know more? OK, go to http://www.socialsecurity.gov/pubs/10536.html and have a real nice day. Are you honestly having trouble affording your Part B premium? OK, think “Medicare Savings Programs,” and we’ll come back to that.
• And do you remember that when you first get Medicare Part B, you get (or got) a “Welcome to Medicare” physical exam as a freebie? OK, beginning this year (which is 2011, remember? Short-term memory is the second thing to go…), and sounding like a thinly-veiled ploy to lull us all in to thinking that “prevention” might make more sense than highly dramatic and highly EXPENSIVE “cures,” you can access a yearly “wellness visit,” which includes a pretty comprehensive health risk assessment, personalized prevention plans and advice and referral. This can only happen after 12 months on Medicare, which means (more or less) 12 months after your “Welcome to Medicare” physical. If you’re on “original” Medicare, you will have no copay for this, even if you haven’t met your Part B deductible, assuming that your medical provider accepts assignment. If you’re on an Advantage Plan, ask them about a copay or deductible first. Have no idea what I’m talking about? Have another Danish.
• Also beginning this year, there will be no out-of-pocket costs for some preventive services, like cardiovascular disease screening, diabetes screening, flu shots, pap test and pelvics, including breast exams, pneumococcal pneumonia shots and more; again, if you’re on original Medicare, there’ll be no copay, even if you haven’t met Part B deductible, assuming your provider accepts assignment. And if you have an Advantage Plan, ask them – First!
•  Last one for today: We’re all hearing a lot about budget cuts, and it doesn’t take long for them all to blur into a mass of unfathomable acronyms and programs, but here’s one that matters. If you are enrolled in a Medicare Part D prescription plan, and you are on BOTH Medicare and Medicaid, you know that the State of Washington has been paying your prescription copays - Beginning six days ago, that stopped. That means that you will paying anywhere from $1.10 to $6.30 per prescription, depending upon your actual income. Now, to some folks, that doesn’t sound like much, but if your income is low enough to qualify you for Medicaid, and you have 5,6,7 or more meds, it’s going to get expensive real quick. Be sure that you document these costs to your DSHS Financial Worker, and remember that you can always call any of the numbers at the end of this column to talk to decent folks who will try to help you, for free.

Enough? Pretty boring stuff, you say? Well, you ought to be in here! – But, the fact is that we’re all just trying to stay alive in America in 2011, and that requires paying attention – Entertainment, alas, is secondary.

And because that is what most of us are trying to do, I’m going to torture us all for the next two Thursdays talking about a couple of programs that I happen to know – For a fact! – Are allowing some people to eat more than once a day, so bear with me; specifically the “LIS” and “Medicare Savings Programs” that I threatened you with above.

So, if you really need some entertainment, go see what’s in that tin foil behind the butter – And DON’T call me!