Medicare Preventative Services

2011 is the official start of the 19 year period in which the generation of Americans known as the Baby Boomers start to turn age 65. An average of 10,000 people each and every day will turn age 65 over this time frame. How the country deals with the challenges in this huge shift of the population will affect each and every one of us.

Medicare was introduced in 1965 and has now been a fixture of retirement for the past couple of generations.  Starting in 2011 Medicare has expanded greatly the number of preventative services it will cover either in part or in full. Until a few years ago Medicare did little in the way of preventative services and screenings but as the long-term benefits of such tests became more self-evident the scope of those Medicare covered tests have increased.

About 5 years ago Medicare included a “Welcome to Medicare” physical which was a one time exam that had to be used during a persons first 12 months on the Medicare program. Now in 2011 Medicare will cover 100% an “Annual Wellness Visit”. This visit is intended to allow a physician and the patient review and develop a prevention plan based upon their health and current risk factors.

In total there are over 15 tests, screenings and immunizations that are now covered under Medicare. For a complete listing please go to www.Medicare.gov, and click on the “Manage your Health” tab on the top tool bar and then click the “Preventative Services Checklist”. It is strongly recommended that you print out this list and make an appointment with your health care provider to review it, and develop a plan to meet your needs.

If you are not able to access a computer a free copy of this print-out is available from my office, so please stop by and ask for your copy.

In addition to the expanded preventative services offered under Medicare for those folks over the age of 65, let’s take a quick peek at what is changing for those of us who have not yet reached that magical age.

Starting in 2011 all individual and group health insurance plans have to cover “Preventative Services” with no co-pays or deductibles.  For example I have recently turned age 50 and it is now time for me to go and have that most fun test of them all, the colonoscopy. About the only good thing that can be said about that test is that at least I won’t have to pay for the privilege of having someone do that to me.

I believe I have mentioned in previous articles that due to the expanded coverage for preventative services for both those under as well as those over age 65 I would anticipate even longer waiting periods to see an actual physician.  On the other hand, once everyone has seen their provider for a preventative check-up hopefully the number of conditions requiring attention can decrease and thereby free up some open slots in the providers calendars. I think that may be a bit of wishful thinking.

2010 Open Season in Closing

Most people are aware that December 31st marked the final day of the 2010 Medicare Annual Enrollment Period (AEP) where people could choose their plans for the following year. Well as with most things Medicare there are always a couple of exceptions to the rules.

The big exception this year is for those people whose plan will be no longer available in 2011, whether it is a Part D Plan or a Medicare Advantage (MAPD) plan. These included the ever popular plans from Sterling, Secure Horizons, UniCare and Humana Gold Choice plans.

If you had one of these MAPD plans and did not make a decision about coverage for 2011, you are not too late. You will still be able to choose a new plan for 2011, however the coverage would start in February as opposed to January. There were over 1,300 persons on Medicare in Clallam County who were losing their coverage and I hope everyone had made a switch by the end of the year.

In previous years people had the opportunity to join a MAPD plan at anytime from January 1st to March 31st, this special election period has been changed for 2011.
Now between January 1st and February 15th a person who enrolled into an MAPD Plan for a January effective date has the ability to disenroll and return to original Medicare. This is a new, shorter period and does not allow for the switching between different MAPD plans.
And finally, we are less than 9 ½ months away from the 2011 open season. The dates have been changed to October 15th to December 7th for each year from now on.

I personally am thrilled as it was crazy for people to enroll on December 31st and have their coverage be effective the very next day, January 1st. By having the cut off be 3 weeks earlier, it means that members are almost assured of having their ID cards and details prior to the New Year. The pharmacists will be able to find people in the respective systems without having to perform computer gymnastics to process claims. The insurance companies they will not have to go back and reprocess millions of claims that were processed under old plans and finally for your local insurance agents and SHIBA volunteers we will be able to finally enjoy Christmas and New Year for the first time in 6 long years.

In closing I would like to wish everyone a safe and Happy New Year.