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Jan 05

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Medicare in the new year

By Bob Moos

The New Year brings improvements and other changes to Medicare. Here’s a brief rundown of what you can expect in 2012.
• Original Medicare covers more preventive services.
Screenings for cardiovascular disease and obesity have been added to the preventive services available at no out-of-pocket cost to people with Medicare.
The new benefit covers one doctor visit each year to determine the best way for you to ward off cardiovascular disease. Your physician may screen you for hypertension and discuss how changes in your diet can lower the risk of heart disease or a stroke.
The free screening for obesity includes regular counseling sessions at your doctor’s office if you have a body mass index of 30 or higher. Anyone who loses at least six pounds during the first six months qualifies for six more months of counseling.
• Generic drugs get a bigger price break in the “doughnut hole.”
If you have a Medicare drug plan and reach the coverage gap, you receive a bigger discount on your generic prescriptions – 14 percent in 2012, compared with 7 percent last year. And, like last year, you still get a 50 percent discount on brand-name drugs in the doughnut hole.
Those price breaks are adding up. More than 2.7 million people have saved more than $1.5 billion on their prescriptions in the coverage gap – an average of $569 per person.
• Medicare premiums change slightly – sometimes for the better.
The monthly premiums for the part of Medicare that covers doctor visits and outpatient hospital services increase for most people by only $3.50, to $99.90, in 2012. If you joined Medicare in the last few years and paid up to $115.40, your premiums actually fall, to $99.90, this year.
A small proportion of people with Medicare – about 4 percent – pay extra for their Part B coverage because their annual incomes are higher than $85,000. They, too, can expect to see their monthly Medicare premiums for doctor visits and outpatient hospital services drop in 2012.
• Now’s the time to switch from a Medicare Advantage plan to Original Medicare if you’re dissatisfied.
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 select a drug plan to go with your new coverage.
A word of caution here: There are two things you can’t do during the six-week disenrollment period. You can’t sign up for a Medicare Advantage plan for the first time. And you can’t switch from one Advantage plan to another.
• Checking out the quality of hospitals and nursing home becomes easier.
It can be difficult to find hospitals, nursing homes, home health agencies and other health care providers that meet your needs. You can now use Medicare’s new “Quality Care Finder” at www.Medicare.gov/QualityCareFinder to compare similar kinds of providers.
The improved online tool describes the quality of care at specific facilities – such as how well a hospital protects outpatients from surgical infections and what steps a home health agency takes to manage pain, treat wounds and keep patients safe.
• Doctors and hospitals are coordinating your care better.
Medicare has begun to work with “accountable care organizations” that will promote better coordination between health care providers so that people with chronic conditions like diabetes and high blood pressure get the care they need to stay out of the hospital.
A lack of coordination has sometimes led to unnecessary tests and procedures. Accountable care organizations will encourage primary care physicians, specialists and hospitals to communicate more so that you get the right care, in the right place, at the right time.
If your doctor participates in one of the new groups, you’ll be notified. But it’s important to remember that your Medicare benefits stay the same. You can still see any doctor who accepts Medicare.
This is just a quick look at Medicare’s more noteworthy changes.  The “Medicare and You 2012” handbook you recently received in the mail will have a complete summary. If you need a book, call 1-800-MEDICARE to request a free copy, or visit www.Medicare.gov and download it.

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