Medicare changes for 2011

Starting Jan. 1, Medicare pays for an annual physical exam, Pap lab test, Pap test speciment collection and pelvic and breast exams, digital rectal exam and PSA (Prostate Specific Antigen) test. Medicare, however, pays only 80% of the charge for the doctor visit.

If you’re part of a Medicare Advantage Plan, such as the Aetna plan that the Beacon Journal uses for its employees, you don’t need and can’t be sold a Medigap policy.

Medicare pays for your flu shot each year. It costs you nothing. So get one!

Medicare will pay some of your prescription drugs costs if:

a. You’re single with income less than $16,245 and resources less than $12,510.
b. You’re married, living with a spouse and your income is less than $21,855 and resources less than $25,010.

Resources include your checking and savings accounts, stocks and bonds but not your home, car, burial plot, up to $1,500 per person for burial expenses or life insurance policies.

Aetna and other Medicare Advantage plans can’t charge more for chemotherapy, dialysis services and skilled nursing care than the government’s competing Original Medicare plan charges.

After you hit the drugs donut hole, you’ll pay 50% of the cost of brand-name drugs and get a 7% discount on generic drugs. The $250 rebate you got in 2010 will continue in 2011. The donut hole will be $2,840, no matter who paid for the drugs. But the formula switches to your out-of-pocket costs to get to $4,550, when you pay no more than 5% of the drug’s cost. People rarely get out of the donut hole. By 2020, unless the makeup of Congress and the White House changes, there’ll be no donut hole.

There will be no Cost of Living increase in your Social Security check, and no increase in your Medicare Part B Premium deduction from your monthly check. If you’re paying $96.40 or $110.50 it will stay the same. Individuals whose income is at least $85,000 or married couples whose income is at least $170,000 pay more for their premiums.

Obamacare freezes 2011 payment rates for Medicare Advantage plans, such as the Aetna MA that the BJ uses, at the 2010 payment levels, which shoots down the BJ’s complaint that it has to pay more as a reason to further dilute retirees’ health care coverage.

The BJ promised more than three weeks ago that it would send an Aetna kit with details on the changes for 2011 in two or three weeks. I haven’t gotten mine yet. Click on the headline to see the story about the BJ’s letter.