Will my premiums go up? On average, premiums for stand-alone drug plans will rise by $1 a month, according to Medicare officials. But a more detailed analysis from Avalere Health, a consulting company that tracks Part D trends, finds some people will see their current premiums drop next year while others will see big increases. Among the 10 drug plans with the most people enrolled, three will have lower premiums: On average, the AARP MedicareRx Preferred plan’s premiums will drop by about 11 percent, and the CVS Caremark Value and Advantage Star plans by about 2 percent. Among the seven others, average premiums will rise by varying degrees, from nearly 3 percent in the Community CCRx Basic plan to nearly 20 percent in the First Health Part D Premier plan.
New Medicare Benefits and Changes for 2011
Once your total drug costs reach $4,550 (see the Ms. Medicare column "Paying Less for Drugs in the Doughnut Hole" for details about how this is calculated), you are eligible for "catastrophic coverage" and your prescription costs drop to a lower copay for the remainder of the year. Last year, when there were no doughnut-hole discounts, $250 rebate checks were sent to all affected Part D subscribers. Because of the discounts now in place, there will be no rebate checks for 2011 expenses. Another 2011 change for Part D subscribers is that if you have a high annual income (more than $85,000 for individuals and $170,000 for couples) and pay higher-income premiums for Part B, you’ll also pay a higher premium for Part D drug coverage.
Medicare Changes Effective January 1, 2011
Other than the changes to the income-related Part B and Part D premiums, most Medicare beneficiaries can expect to see savings in their out-of-pocket costs as a result of the changes described above. The DMEPOS competitive bidding program is designed to reduce the cost of durable medical equipment, prosthetics, orthotics, and supplies. The new focus on prevention eliminates cost-sharing for important services and allows beneficiaries to meet yearly with their medical providers to establish or update a screening schedule. MA plans have new restrictions on the cost-sharing they may impose. Beneficiaries who enter the donut hole will pay less for their medications. All in all, the changes to Medicare that go into effect in 2011 will bring improvements to the lives of millions of older people and people with disabilities.
Medicare Changes in 2011 Relevant to Lymphedema
CMS is adopting a MPPR policy for therapy services in 2011 in order to more appropriately recognize the efficiencies when combinations of therapy services are furnished together. The policy states that the MPPR for “always” therapy services (e, g, therapeutic exercise, manual therapy, self-care management) will reduce by 25 percent the payment for the practice expense component of the second and subsequent therapy services furnished by a single provider to a beneficiary on a single date of service. Since publication of the 2011 Medicare Physician Fee Schedule (MPFS) final rule, this policy has been modified by the Physician Payment and Therapy Relief Act of 2010. Per this Act, CMS will apply the CY 2011 MPFS final rule policy of a 25 percent MPPR to therapy services furnished in outpatient settings and a 20 percent therapy MPPR will apply to therapy services furnished in clinician’s office settings.
2011 Changes to the Medicare Part D Coverage Gap (Donut Hole)
With this discount, they will only pay 50% of the price for the brand-name drug, but the entire price (including the 50% discount the drug company pays) will count toward the amount needed to qualify for catastrophic coverage. The EOB notice will show any discounts paid by the drug companies. The beneficiary will still need to pay any dispensing fee (cost to fill a prescription). The dispensing fee isn’t discounted; it is added to the discounted amount of your prescription.
Medicare.gov: the official U.S. government site for Medicare