Much has been written about healthcare reform over the last couple of years. Some changes have already taken place and when it comes to Medicare, you may have already noticed some of the differences
1. Closing the “donut hole.”
That's the nickname for the coverage gap that occurs in some Medicare Prescription Drug Plans. Once costs for prescription medicines reach a certain amount, you enter the donut hole. The Affordable Care Act, which went into effect on March 23, 2010, created the "Medicare Prescription Coverage Gap Discount Program" to help fill that gap. It provides manufacturer discounts of 50% on covered brand-name drugs. If you’re a Medicare member, the system keeps track of how much you spend on medications and the discounts are automatic once you reach the coverage gap.
Note: Not all brand-name drugs are covered under these benefits. Only the drug companies that agree with the terms and conditions of the Centers for Medicare and Medicaid Services (CMS) work with Medicare plans.
There are also discounts for those who prefer to buy lower-cost generic prescription medications while in the doughnut hole. Medicare beneficiaries with Plan D coverage get a discount of 21% on generic prescription drugs in 2013, and 28% in 2014 (up from 14% in 2012).
2. Changes in Enrollment Periods.
In the past, people with Medicare enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDP) from October 15 through December 7 -- called the Annual Election Period (AEP) -- for the following year’s coverage. Your plan selection became effective on January 1. There were rules in place if you wanted to change your MA plan or prescription drug coverage on or after the first of the year. Now that’s changed and there’s a time called the Annual Disenrollment Period (ADP).
Starting in 2013, the ADP is January 1 through February 14 each year. During this time, people who have a Medicare Advantage plan are able to drop their MA coverage and go back to Original Medicare. You will not be able to enroll in a different Medicare Advantage plan, but you can enroll in a stand-alone prescription drug plan.
3. Preventive Care Benefits.
Some of the law’s changes emphasize preventive care to help people of all ages stay healthy. Seniors are eligible for annual wellness checkups, vaccines and flu shots, cancer screenings and more without cost-sharing. Check with your plan to see if qualify.
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This information is only a high-level summary of certain provisions of the health care law. This information does NOT attempt to summarize all provisions of the health care reform law. This information is not and should NOT be used as legal or tax advice; it should not be used as a basis for decisions regarding how the health care reform law will affect you and/or your business. Should you have any questions on how the health care reform law (including the high level summary of certain provisions of health care reform) will affect you and/or your business, you should seek professional advice from attorneys or other advisors.
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