Coverage will go up until the gap disappears
Because of the way the 2003 Medicare Part D law was written, there is a gap in seniors' drug coverage known as the "doughnut hole."
After you pay a deductible for prescription drugs ($310 this year), you are liable for a 25 percent co-payment on prescriptions. Until you fall into the doughnut hole. In 2010, coverage will stop when you've spent a total of $2,830 on prescriptions; then you will be responsible for 100 percent of the cost of drugs.
If you spend an additional $4,550 out of pocket for prescriptions, a "catastrophic" benefit then kicks in, and you pay only 5 percent of the total cost (the other side of the doughnut).
The Patient Protection and Affordable Care Act offers a mere $250 to cover the doughnut hole in 2010. But the coverage increases in succeeding years, until the doughnut hole disappears in 2020.
FREE SCREENINGS
Preventive services get easier in 2011
The new law guarantees that basic Medicare benefits will not be cut, according to AARP's online Bulletin.
In addition, in 2011 all Medicare preventive services, such as screenings for colon, prostate and breast cancer, will be free. Annual wellness visits also will be free starting next year.
MEDICARE ADVANTAGE
Changes may mean higher premiums
Congress launched Medicare Advantage in 2003 (a precursor program, Medicare+Choice, began in 1997) because it hoped private companies could administer plans more cheaply than the government could. That has turned out not to be the case. Private insurers have tried to sweeten Medicare Advantage by offering such perks as free glasses, hearing aids and gym memberships. These may disappear as, beginning in 2012, the government begins substantially reducing its subsidies to Medicare Advantage plans. The nearly 10 million people enrolled in the plans may be facing higher premiums or lesser benefits.
CHANGING PAYMENTS
2013 pilot program will test bundling
Medicare has always been a "fee for service" system in which doctors and hospitals are paid for each service they render. A pilot program beginning in 2013 would steer Medicare away from fee for service, which some say leads to more tests and visits and procedures but not necessarily to better care. Instead, the pilot program will test making single, "bundled" payments to hospitals and doctors for certain procedures, rather than making separate payments to each, which may encourage them to work together to control quality and costs.
