Gainesville Daily Register

December 4, 2012

Medicare officials announce changes

Special to the Register
Gainesville Daily Register

Gainesville — The new year will bring improvements and other changes to Medicare, according to a representative of the Centers for Medicare and Medicaid Services.

Bob Moos, the agency’s southwest public affairs officer, recently offered a brief rundown of what to expect in 2013. He said Medicare recipients can expect bigger price breaks on brand-name and generic drugs in the basic Medicare Part D plan, which includes something known as the “doughnut hole.”

As a recap, the Part D plan includes these terms:

• You pay out-of-pocket for monthly Part D premiums all year.

• You pay 100 percent of your drug costs until you reach the $310 deductible amount.

• After reaching the deductible, you pay 25 percent of the cost of your drugs, while the Part D plan pays the rest, until the total you and your plan spend on your drugs reaches $2,800.

• Once you reach this limit, you have hit the coverage gap referred to as the “doughnut hole,” and you are now responsible for the full cost of your drugs until the total you have spent for your drugs reaches the yearly out-of-pocket spending limit of $4,550.

• After this yearly spending limit, you are only responsible for a small amount of the cost, usually 5 percent of the cost of your drugs.

Moos explained that if you have a Medicare drug plan and reach the coverage gap, you'll receive bigger discounts on your prescriptions - about 53 percent for brand-name drugs in 2013 (compared with 50 percent this past year) and 21 percent for generics (compared with 14 percent in 2012).

The price breaks are adding up. Almost 158,800 Texans with Medicare have saved $103.4 million on their prescriptions in the coverage gap this past year - an average of $651 per person. The discounts will continue to grow each year until the “doughnut hole” disappears in 2020.

Medicare premiums will increase only slightly. The monthly premium for the part of Medicare that covers doctor visits and outpatient hospital care will increase for most people by only $5, to $104.90, in 2013. The Part B premium has gone up slowly over the past five years - an average of less than 2 percent annually.

The standard premium amount is calculated each year according to a mathematical formula. It takes into account Medicare's costs the previous year and the fact that the government pays 75 percent of Part B's costs while beneficiaries pay the other 25 percent. A small number of people with Medicare — about 4 percent — pay surcharges on their Part B premiums because their annual incomes are higher than $85,000. They, too, will see only a slight increase in their premiums for physician visits and outpatient services. Medicare deductibles will increase modestly.

Besides new premiums, there are new deductibles for 2013. These are the amounts you pay out of pocket each year before Medicare kicks in and covers its share of the bills.

The Part B deductible for doctor appointments and other outpatient care will be $147, compared with $140 this past year.  The Part A deductible for up to 60 days of inpatient hospital services will increase about 2 percent, from $1,156 in 2012 to $1,184 in 2013.

If you're dissatisfied with your Medicare Advantage plan, you can quit it beginning Jan. 1. If you're unhappy with your private Medicare Advantage health plan, an annual "disenrollment" period allows you to return to the traditional fee-for-service Medicare program between Jan. 1 and Feb. 14. You can also pick a drug plan to go with your new coverage.

A word of caution here: There are a few things you can't do during the six-week disenrollment period. You can't switch from one Medicare Advantage plan to another. Nor can you switch from the traditional Medicare program to an Advantage plan. Most people will need to wait until the annual enrollment period in the fall to make either of those changes.

You'll pay less for walkers, wheelchairs and other medical equipment. You're likely to reap hundreds of dollars in savings each year from the new way that Medicare will pay for medical equipment like home hospital beds, walkers and wheelchairs. The reform takes effect in dozens of additional metropolitan areas starting July 1.

The government is replacing an outdated fee schedule with a new system that requires equipment suppliers to bid for Medicare's business.

Beneficiaries have enjoyed substantial price reductions in the first nine areas where Medicare has tried competitive bidding. Among the next areas to see lower costs on medical equipment and supplies beginning this summer will be Austin-Round Rock-San Marcos, Beaumont-Port Arthur, El Paso, Houston-Sugar Land-Baytown, McAllen-Edinburg-Mission and San Antonio-New Braunfels. All areas of the country will benefit from competitive pricing within a few years. For more information, call 1-800-MEDICARE or visit medicare.gov.