Republicans want to repeal the 2010 Affordable Care Act which impacts a broad range of medical and health  insurance issues.  Many of the reforms are actually quite popular with the public.  Here are some changes that will affect Medicare beneficiaries in 2011.

Medicare will increase payments for primary care services by 10 percent. This increase applies to all fees for services provided by primary care physicians as well as nurses, nurse practitioners, and physician assistants.

Preventive health services, such as vaccinations and cancer screenings, will be covered for people on Original Medicare at no cost to the patient. Also, Medicare beneficiaries can now get a free annual “wellness exam” from their doctors.  Note:  People enrolled in Medicare Advantage plans have had these preventive and wellness benefits for many years. Medicare seems to have learned from the Medicare Advantage model which encourage seniors to get preventive screenings.

The Part D doughnut hole is being changed in 2011. Anyone who falls into the doughnut hole in 2011 will receive a 50% discount on their brand drugs while they are in the gap.  Generics will be discounted by 8%.  So a person whose brand drug costs are $500 per month would pay $250 instead.  This should provide serious relief to people who take expensive brand drugs.

Medicare Advantage plan payments from Medicare will be frozen at 2010 levels, so 2011 Advantage plans have not seen major changes to benefits. Actual reductions in what Medicare pays Advantage plans will begin in 2012, so we’ll have to wait and see what the plans will look like next year.

In the meantime, the Advantage plans will be working hard to upgrade their customer service so they qualify for bonus payments Medicare will offer to plans that get three or more stars on the Medicare.gov rating system.  People enrolled in Medicare Advantage plans can expect more attention from their plan this year, which might be a good thing.

I met with a man who recently lost his wife to a long illness. He was still getting over his loss when he received a letter from his credit card company informing him that his card had been canceled.  He called the credit card company and was told his account had been closed because he was dead.

It seems Social Security made a mistake when his wife died and instead put into his record that he was deceased.  This information probably goes to credit reporting agencies and was picked up by his credit card company.  He told the company he was alive and well and would like to pay his last bill, which had been held by the company.  The company would not send him the bill so he could pay it because, according to their records, he was deceased.

This man called Social Security and pointed out their error.  He was told his record would  be corrected. That was three weeks ago.

This man has a Medicare Advantage plan that is being canceled and he needs to enroll in another plan, so I submitted an application for him to the AARP Medicare Complete Plus plan by UnitedHealthcare.  I checked the next day on my computer to see that his application had been received and I saw the notation, “Denied due to death”.

I’ve decided to mention the name of the company because I know they read everything that is written about them, and I mght need some help from higher up to fix this problem.

Medicare Advantage companies check the Medicare record of each applicant to make sure the information on the application is correct before they send the file to Medicare.  Medicare had gotten the report of this man’s death from Social Security, but two weeks after Social Security corrected his record, Medicare had not received the correction.

This should be an interesting case to see how two large government bureaucracies work. And UnitedHealthcare is so large that I have often said it is like the government.  We’ll see how this turns out. And hopefully it gets resolved soon because this man only has until the end of December to get enrolled in a new Medicare Advantage plan. If he misses that deadline there will be another bureaucratic mess to deal with.

Medicare beneficiaries have until the end of December to make changes to their Medicare coverage if they are thinking about moving to another Medicare Advantage plan or stand-alone Part D drug plan.  Folks who have only Medicare and no supplement may want to consider their options among Medicare Advantage plans and Medicare supplements.  But everyone must make changes before December 31st.

Medicare supplements can be purchased at any time of the year, but Part D plan enrollment is only allowed between November 15 and December 31 (unless a person is new to Medicare, moving to a new state, or has a low income subsidy for drug costs).

In past years, Medicare beneficiaries had the “Open Enrollment Period” of January through March, during which they could change to another Medicare Advantage plan.  That change period is no longer available, so everyone will be “locked into” their Medicare Advantage plan for all of 2011 as of January 1.

There is a new “dis-enrollment period” for Medicare Advantage which runs from January 1 to February 14th.  If a person decides in January that he doesn’t like his Medicare Advantage plan, he can dis-enroll from that plan, return to Original Medicare, and get a stand-alone Part D drug plan.

A trend among people I am dealing with is to move from Medicare Advantage back to Medicare and purchase a Medicare supplement.  When turning 65, many healthy people choose to enroll in a Medicare Advantage plan because of the $0 monthly premium and inclusion of Part D in the plan. But I’ve been talking to people, some who are healthy and some who are not, who have decided they want to get a Medicare supplement while they can.  They have decided they would prefer to pay in advance for complete (or nearly complete coverage) they get with a Medicare supplement rather than the pay-as-you-go system of Medicare Advantage.

Medicare gives people a one-year trial period for Medicare Advantage, after which a person can return to Medicare and get a Medicare supplement without answering medical questions.

One Medicare supplement company offers a two-year Medicare Advantage trial period and will accept a person for their Med Supp even if they have health issues.

Another company is taking applications for it Plan N Med Supp with no medical questions asked.  I have warned my clients that this option – if it is their only Medicare supplement option  – should be considered with the understanding that the premium for this Plan N will likely shoot up quickly and substantially.  This is because everyone enrolling in this plan is likely to have health issues which will cause the company to have high claims costs.

People who are happy with their current Medicare coverage don’t need to do anything. Their Medicare Advantage plan coverage, Medicare Supplement, or Part D coverage will roll over for 2011.

There are quite a few people who are enrolled in plans that are being canceled or are changing substantially.  Anyone enrolled in a private-fee-for-service plan (PFFS) should look closely at their plan costs and coverage. Many of these plans are being canceled and people enrolled in them received a letter announcing this in October.

One PFFS plan remains, but is as expensive as a Med Supp plan, and yet this PFFS plan has lots of co-pays.  PFFS plans in outlying areas of the state may be the only Medicare Advantage option for people in places like Yuma and Safford, so they may offer some value even if their premium is much higher than plans offered in urban areas.

Health Net’s Amber plan is changing to a “dual-eligible” AHCCCS/Medicaid plan only.  I have heard that Health Net has finally sent a letter to people enrolled in this plan who are not “full dual” to inform them that they must change to another plan.  These are people whose co-pays are not covered by AHCCCS (Arizona’s Medicaid). They will be shocked to see the co-pays in the “regular” Medicare Advantage plans that are double and triple what they paid through the Amber plan.