Ageism 2011
A New Beginning Again

Healthcare Changes for 2011

category_bug_journal2.gif For the second year in a row, there is no Social Security cost-of-living increase for 2011, due to the federal government's determination that there was no inflation last year.

We all know that's not true – just look at your grocery bill, monthly heating and cooling bills, cable television charges, etc., and particularly Medicare Part D and Supplemental Coverage premiums. We will just have to eat those increases, but there is some good news on the health care front.

SOCIAL SECURITY BENEFITS CHECKS
Although not directly related to health care, this is important to know: Beginning on 1 May, all new Social Security beneficiaries will be required to accept paperless payments - that is, debit cards or direct deposit to bank accounts. The new requirement also affects other federal payments such a VA, SSI and the Railroad Retirement Board.

Current beneficiaries have until 1 March 2013 to make the change. People 90 and older along with those who live in remote areas far from banks are exempt.

The switch is expected to save the government $1 billion over 10 years. You can get more information at this government website or call this toll-free number: 1-800-333-1795.

MEDICARE PART B PREMIUMS
For the majority of enrollees, in years when there is no cost-of-living increase to Social Security, Medicare Part B premiums are not allowed to increase. Medicare beneficiaries who have their Part B premium deducted from their monthly Social Security benefit and have incomes of $85,000 or less will continue to pay $96.40 through 2011. (Some pay $110.50.)

For all others in that group, the monthly premium is $115.40.

People with incomes greater than $85,000 (and couples filing joint IRS returns with incomes above $170,000) will see an increase of 4.4 percent and pay anywhere from $161.50 to $369.10 on a graduated income scale based on 2009 IRS income.

PHYSICIAN PAYMENTS
Time Goes By readers have reported in the past that they have been “fired” by their physicians who stop seeing Medicare patients. In an effort to slow the outflow, primary care physicians, including nurses, nurse practitioners and physician assistants, with 60 percent or more of their services devoted to primary care will get a 10 percent increase in their payments from Medicare beginning now.

Also, general surgeons will receive the increase if they practice in areas where there are shortages.

It's not a lot to retain Medicare physicians, but it's a beginning. However, the benefit expires at the end of 2015.

ANNUAL WELLNESS EXAMINATION
New Medicare rules now require a free annual wellness exam which includes a review of the patient's medical history along with a schedule of screenings for the coming decade and a personalized prevention plan.

For those just joining Medicare, the 20 percent co-pay for the Welcome to Medicare physical exam has been eliminated.

PREVENTION
You will want to keep a close eye on those new tea party and Republican Congress members who have pledged to get rid of what they call Obamacare because it includes some excellent prevention provisions for Medicare enrollees.

Beginning now, health prevention services such as vaccinations, screenings for cancer, bone mass loss and more that are Medicare-covered are free – no co-pays or deductibles – if they are rated A or B by the U.S. Preventive Services Task Force. You can see their A/B list here. Be sure to compare it to the approved list in your annual Medicare 2011 book or online here.

RESTAURANT FOOD LABELING
It is shocking, sometimes, how many calories are in fast food and it is difficult to get that information. That's about to change. Although it is unlikely to happen before next December, chain restaurants with more than 20 locations and owners of 20 or more vending machines will then be required to post calorie information. Such restaurants will also be required to provide customers with a brochure listing more detailed nutritional information.

You can see a Food and Drug Administration Q&A on the development of these new requirements here.

PRESCRIPTION DRUGS
The “doughnut hole” in Medicare Part D coverage for prescription drugs is notorious, a plague foisted on elders to further enrich the pharmaceutical companies when the law, written by big pharma, went into effect in 2006. Many old people stop taking their drugs when they hit the gap during which they must pay full price.

Now there is some small relief as drug companies are required to give Part D enrolees a 50 percent reduction on brand-name drugs while they are in the doughnut hole and generics will also be cheaper.

Personal costs could be reduced by $700 for typical Medicare enrollees and the National Council on Aging estimates that savings could reach as much as $1800.

ADVANTAGE PLANS
About 25 percent of Medicare beneficiaries subscribe to private Advantage plans that cover all the parts of traditional Medicare in one fell swoop. Because Medicare pays Advantage plan providers $1000 or more per person above the average cost of traditional Medicare patients, traditional Medicare enrollees subsidize these plans with higher premiums for their coverage than would be necessary if everyone was enrolled in traditional Medicare.

This year, Medicare has frozen their payments to Advantage plan providers at 2010 levels and lower rates will be phased in beginning in 2012 until the payments are eventually eliminated.

Insurance companies will respond in various ways – by raising premiums or co-pays in some cases, reducing the number of network providers or by reducing or eliminating such benefits as vision and dental care which are not covered in traditional Medicare.

Current Advantage enrollees who wish to join or return to traditional Medicare have 90 45 days - until 14 February - to do so.

FIGHTING HOSPITAL INFECTIONS
It is estimated that each year 1.7 million hospital patients suffer life-threatening but preventable infections and some die – estimates range from 20,000 or so to more than 100,000.

Beginning in July, Medicaid will stop paying for treatment of some hospital-acquired, preventable infections – something Medicare and some private insurers already do.

Presumably, this will encourage hospitals to impose enormously successful and simple programs for all employees who come into contact with patients – such as this one. (Subscription may be required.)

END OF LIFE COUNSELING
Remember when Sarah Palin, during the healthcare debate, falsely labeled voluntary end-of-life counseling “death panels”? It was enough to scare those silly Republicans in Congress to strip the provision - which would have reimbursed doctors for counseling their patients - from the health care bill. The Obama administration rescinded this provision on 5 January.

Now, the Obama administration has issued new Medicare guidelines reimbursing physicians for such a conversation during patients' annual wellness checkup. It is still voluntary.

This will help elders think about their options, what life-saving procedures they are willing to endure and prepare them for creating living wills and health care proxies which, now, only a third of Americans have. This is a good thing.


At The Elder Storytelling Place today, Jim Kittelberger: The First Time

Comments

The reality is, it's hard to find a doctor in this 8th largest US city that will take medicare. Mine won't. And starting several days ago, my eye doc won't take my Advantage plan. Because my frames had been repaired once, I bought new ones on their recommendation. Grrrr. And felt the fool too.

This was a very encouraging post. Direct deposit makes a lot of sense for government checks. Still, saving money this way will surely cost jobs. (Nonetheless most of my banking is done through an online bank and I would never want to go back to the old way--so much easier.
Also, I think end of life care could be managed so much better if the elderly were encouraged to state their wishes in advance--it's just something people tend to put off. I don't believe that most want to be kept alive at any cost when there is no hope for enjoyment--and it's very expensive.

Regarding restaurants listing calories on their menus. They've been doing this in New York state for a couple of years and the consensus is that it does not change consumption habits--sometimes you just want a big cheeseburger. But what does seem to help is asking if the customer would like to be served a smaller portion of the sides (French Fries). Even better would be to freely promote a small salad instead of Fries.

Nice synopsis Ronnie. I almost never agree with Nancy Pelosi, but I this time I do. The Republicans should focus on job creation.

I also think Mr Obama is correct, the good things in the new law should be left alone and the bad things removed (i.e. revise the sections of the law that are problematic). There are a few bad things in this law, as there always are in a law this big.

People need to realize it's far better to go with the traditional Medicare even if they think they're in great shape because you never know when a catastrophic illness might surprise you. At least investigate the difference.

Good overview. Thanks.

I agree--great overview, Ronni. I can't believe that only 1/3 of Americans have living wills and healthcare proxies! I wonder if this includes Americans of ALL ages? Although my personal bias is that everyone should have these documents (the proverbial getting hit by a truck can happen at any age), it's really essential for those of us over 65 to have them. Forms are readily available online from a number of sources.

Not only do my husband and I have living wills and healthcare proxies, we've also signed a POLST (Physician Orders for Life Sustaining Treatment) stipulating what we do NOT want done. I've also signed a "Five Wishes" document and written a 3-page letter (updated annually)to family members, with copies to my next-door neighbors, stating my end-of-life wishes in no uncertain terms.

It's totally frightening to contemplate ending up a patient (prisoner?) in the ICU during my last few months/weeks of life--especially after reading the excellent New Yorker article you provided a link to. That should give us all pause for thought!

I should probably add that I think ICU checklists (and medical checklists in general) are a terrific idea. Kudos to the doctors and hospitals who use them. However, it doesn't change the fact that very elderly patients in the last stage of life all too frequently end up in the ICU. In most cases no number of checklists in the world can return a failing 89-year old body to any semblance of quality life (in my view). Of course, each individual must make his/her own personal choices and retain the absolute legal right to do so.

What!!! Required health screening each year?? What does this mean? George Orwell you were right. -- barbara
P.S. What happens if you refuse your health wellness checkup? Who is benefiting here -- the medical industry or the medicare person. Nice tracking system.

Barbara...

I didn't word that section well. Patients are not required to have an annual wellness exam, but Medicare is required to pay for one.

In the past, Medicare did not pay for an annual exam after the first Welcome to Medicare physical.

I wonder what Medicare will look like by the time I am eligible. Thanks for keeping me educated, Ronni.

No Cost of living increase has caused me to stop taking some of my medication I also don't ever hear about COL at all from anyone in Government, or even an advocate.

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