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Remember these are proposed changes and may be changed prior to being passed.
The Centers for Medicare & Medicaid Services have announced the following changes for 2010 and are detailed in the Federal Register / Vo. 74, No 78 / Friday, April 24, 2009 / Notices document.
Insurers are prohibited from denying or conditioning the insurance or effectiveness of a policy, or discriminating in the pricing of the policy based on individuals genetic information: also, issuers are prohibited from requesting or requiring an individual or family member of an individual to undergo a genetic test.
Added Hospice coverage as a Basic “Core” benefit to all plans, as similar coverage was added as basic benefit in plans “K” and “L”.
Deleted coverage for Preventive and At-Home Recovery. The NAIC concluded that Medicare Part B has changed to cover many more preventive benefits, and the usefulness of this benefit in a Medigap policy was significantly reduced, covering only part of an annual physical after Medicare had made this benefit less meaningful.
Created a new plan D, which is identical to the current plan D except that the At-Home Recovery benefit was deleted.
Created a new plan G, which is identical to the current plan G except that the 80% Medicare Part B Excess charge benefit would be replaced by 100% Medicare Part B Excess charge.benefit, and the At-Home Recovery benefit was deleted.
Eliminated the current “E”, “H”, “I” and “J” plans as they duplicated existing plans.
Created a new plan “M”, which duplicates plan D but with a 50% coinsurance on the Part A deductible.
Created a new plan “N” which duplicates plan D with the Part B coinsurance being paid at 100% less a $20 co pay per physician visit and co-pay of $50 per emergency room visit, unless the beneficiary was admitted to the hospital.
The changes have created two sets of standardized plans which are known as the “1990 standardized plans” for plans with effective date of coverage prior to June 1, 2010 and “2010 standardized plans” for those after.
MEDICARE ADVANTAGE PROPOSED CHANGES
The following are some changes being tossed around and I expect them to be formally announced soon.
For those of you not familiar with the M.A. plans, they are HMO’s, PPO’s and PFFS. The later stands for Private Fee for Service. They are marketed “You can go to any Doctor or Hospital of your choice, as long as they accept our plan”.
These plans may be eliminated by 2010 or at least by 2011. Anyone on this type plan will have to change to another plan of his or her choice.
Proposed Changes are:
Approximately 10 million M.A. customers should receive premium increases of $40 to $70 per month. This year some have increased by over 5 times from 2008.
An out of pocket expense should be capped at $3400. This means the beneficiary could not spend more than that amount for treatment per year. This does not include their monthly premiums.
In addition to higher premiums, providers are also looking to reduce coverage for an array of services to help offset lower reimbursements by the government. With the typical Medicare Advantage customer on a very tight budget, this increase can immensely affect the quality of life.
SOCIAL SECURITY PAYMENTS
The Congressional Budget Office predicts that social security will not see any cost-of-living adjustments until 2012. Since adjustments are tied to consumer price inflation, which is expected to see little to no increase over the next two years, the CBO believes social security payments will remain the same during that time period.
These are some of the changes and proposed changes we may or will see in the near future.
MEDICARE PART D (Prescription Drug Program)
It now looks like the dreaded “ Donut Hole” or Coverage Gap will change in July 2010.
The drug suppliers have agreed to reduce the cost of brand-name drugs by 50%. This is excellent news for those among us that reach the gap.
(I will be happy to help you choose the right plan for you. There is no charge for this service but you need to call me.) You can do this by using http://www.medicare.gov/ but please let a computer compare all plans for you so you don’t waste your money.
You have questions. I have answers or will get them for you.
bringing you the news: www.texasmedicaresupplementplans.com; www.texasmedicaresupplementplan.com; www.insurancedfw.com
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