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The new health care law includes a significant number of changes that affects Medicare over the next few years. Some of these changes already went into effect on January 1, 2011. The most important changes that will affect Medicare beneficiaries in coming years involve prescription drug costs and out-of-pocket payments for preventive services.
Under the new law — commonly referred to as the Affordable Care Act — you will not see any changes to your eligibility or to your guaranteed Medicare benefits, and you do not have to change doctors. However, the law does provide additional benefits under many Medicare plans that will help you lower your health care costs.
Free preventive services
Effective January 1, 2011, many preventive care services are now provided under Medicare Part B at no cost. Examples of preventive services that are now covered include flu shots, prostrate cancer screenings, Pap tests, and screening mammograms. If you get your coverage through a Medicare Advantage Plan, you should check with your plan to see if the plan offers any additional preventive services beyond what Medicare Part B covers.
In addition, you are now entitled to a free Annual Wellness Visit. This visit allows you and your doctor time to develop, review, or update your personal prevention plan based on your current health condition and needs.
Gradual reduction of the Coverage Gap
One of the biggest changes to Medicare brought about by the health care law is the gradual reduction of the Part D Coverage Gap or "doughnut hole." In 2012, people on Medicare receive a 50 percent discount on the price of their brand-name prescription drugs and a 14 percent discount on the price of generics during the Coverage Gap. In 2013, these discounts will increase to 52.5 percent for brands and 21 percent for generics. The discounts available during this period will continue to grow larger until 2020, by which time your cost will be 25 percent of the full-price for all of your drugs.
The new law also provides for specific changes to Medicare coverage and benefits under Medicare Advantage Plans:
- Medicare Advantage Plans are prevented from charging more than Original Medicare for chemotherapy, dialysis, and skilled nursing facility care.
- Costs to participate in a clinical research study may be lower than in previous years, and some costs may be covered that were not covered prior to 2011.
- A new annual cap applies to how much your Medicare Advantage Plan can charge you for Part A and Part B services. The annual out-of-pocket maximum may vary between Medicare Advantage Plans.
Due to these changes, you may want to review your plan during the Annual Election Period to make sure it is still the best plan for you. For additional information, visit www.Medicare.gov or call 1-800-MEDICARE.