Coming soon to a health care plan near you: The Health-Care Law Provisions Taking Effect in 2011

Change is scary but knowing what to expect helps. Check out the changes to our nation’s healthcare that will be in effect starting in 2011. Please note that most of the big stuff is happening in 2014. -SP

By Katherine Hobson
Parts of the uncatchily named Patient Protection and Affordable Care Act, aka the health-care overhaul law, began to kick in earlier this year. But in 2011, other provisions will roll out — some as soon as January 1.

The Kaiser Family Foundation counts 21 provisions taking effect next year. Among them:

-The requirement that the proportion of premium dollars spent on medical care must amount to at least 80% for small business plans and 85% for large group plans will kick in. The so-called medical loss ratio was the subject of discussion and lobbying this year as insurers jockeyed to meet the requirements — and to avoid paying consumers rebates if they don’t.
It’s the beginning of the end for the Medicare prescription-drug “doughnut hole.” Next year drug makers will provide a 50% discount on brand-name medications that fall into that coverage gap. Federal subsidies for generics will also begin.

-For Medicare beneficiaries, there will be no cost-sharing for certain preventive health services that receive an A or B rating from the U.S. Preventive Services Task Force.

-You won’t be able to pay for OTC drugs out of your flexible spending account, unless those drugs have been prescribed by a physician. (There are some exceptions.) We wrote recently about the change and how to figure out what’s eligible. The same applies to health reimbursement accounts.

-Calorie counts and other nutritional information will be posted on chain-restaurant menus and on food sold via vending machines.
The health-care overhaul law’s major provisions — such as the mandate that almost everyone purchase insurance, the requirement that insurers accept all comers and the establishment of state-based insurance exchanges — don’t take effect until 2014.

Click here to read the full article and the many helpful links at the Wall Street Journal online.

Doctors encourage screening for aortic aneurysms

By Rita Rubin, USA TODAY

U.S. envoy Richard Holbrooke most likely was unaware that his aorta had ballooned into an aneurysm, according to doctors not involved in his care.
Holbrooke, 69, died Monday night after surgeons tried to repair a dissection, or tear, in his aorta, the main artery that carries oxygenated blood from the heart to the rest of the body.

About 3,000 Americans die each year from an aortic dissection, although the actual number probably is higher. If an autopsy isn’t done after someone dies suddenly, “it takes away the opportunity to put pieces of the puzzle together,” says Cam Patterson, chairman of cardiology at the University of North Carolina-Chapel Hill.

Aortic aneurysms don’t cause symptoms, but screening with ultrasound and sometimes CT or MRI scans can detect them before they tear, when they can be easily surgically repaired.

Because the risk of an aortic dissection increases with age, Patterson says, he recommends that all of his patients 65 and older be screened. However, he says, Medicare covers the screening only for men, in whom dissections occur at a younger age, and then only if it’s performed at their first Medicare visit.

Read the full article here at USA Today

Life Inc: Health care costs for retirees could top $100,000

By Allison Linn, senior business writer

If you want to stay healthy in retirement, you better start saving your pennies.

Even with Medicare coverage, new research finds that 65-year-olds who retire this year could need more than $100,000 to cover co-pays, premiums and other non-reimbursed medical expenses through retirement.

The costs are likely to be higher for women than men because women tend to live longer, according to the report from the Employee Benefit Research Institute.

Of course, everyone has different health care needs, and no one really knows what their health will be like in retirement, so there are a lot of uncertainties. And although the researchers believe that the recently passed health care reform bill will reduce some costs for retirees, they say out of pocket expenses remain substantial.

If you are comfortable with a 50 percent chance of having enough money saved for health expenses, the report finds that a man retiring in 2010 at age 65 with average health care expenditures would need $65,000 in savings. A woman in the same circumstances needs $93,000.


7 Tips for Picking a Medicare Part D Plan

AGE is hosting a special event this coming Saturday (11/13/2010) to help seniors and their families learn the ins-and-outs of Medicare for open enrollment. If you can’t make it to our event, check out this helpful article from US News -SP

7 Tips for Picking a Medicare Part D Plan
How to switch into a lower-cost prescription drug plan in 2011
By Emily Brandon

Beginning next week, Medicare Part D beneficiaries will have the opportunity to switch to a new prescription plan. Choosing a plan that covers your medications for a lower cost could save you hundreds of dollars in 2011. About 2.6 million beneficiaries enrolled in prescription drug plans will see a premium increase of at least $10 per month if they stay in their current plan. Current beneficiaries can choose a new Medicare Part D
plan between November 15 and December 31. Here are some important factors to consider when choosing among the Part D plans in your area:

Compare premiums. The average monthly Part D premium will be $40.72 in 2011 if beneficiaries remain in their current plan, which is up 10 percent from $36.90 in 2010, according to a Kaiser Family Foundation analysis. Average premiums vary considerably by location, ranging from $29.01 per month in New Mexico to $46.51 per month in Idaho and Utah. “We have seen plans that have had pretty substantial increases in premiums over the years,” says Jack Hoadley, a health policy analyst at Georgetown University’s Health Policy Institute. “What may have been the cheapest plan for you three or four years ago when you first signed up may not be good for you now.” For the first time, in 2011 there will additional premium increases for high-income retirees. Part D enrollees with annual incomes above $85,000 ($170,000 for couples) will have a monthly adjustment automatically deducted from their Social Security check. If that amount is more than the amount you receive from Social Security, you will get a bill from Medicare.

Read the full article here at US News and World Report’s website.

FREE Event: Health Insurance Options for Seniors

Learn more about the health insurance options for seniors including recent
changes in the law from a panel of experts.

Panelists include:
Norma Almanza, HICAP Coordinator, Texas Department of Insurance
Patricia Longoria, Director of Community Relations, Physicians Health Choice

Join us in the AGE Building Dining Room
3710 Cedar Street, Austin, 78705
Saturday, November 13

For more information or to pre-register, please call Bruce Kravitz at (512) 451-4611 or email Respite is available on-site at Elderhaven by reservation only.

To RSVP for respite, contact Katy Rouse at (512) 458-6305 by November 10. Elderhaven is an Adult Day Center that provides care daily (M-F) for the elderly with nurse oversight in Travis and Williamson Counties. Call 458-6305 for more information.

Medicare’s Annual Open Enrollment is November 15 – December 31

From Right at

Help senior loved ones select a quality plan. The Medicare website offers tools to help compare supplemental ("Medigap") and prescription plans in your area. Download "Use Medicare's Information on Quality to Help You Compare" to learn more about things to look for.
The same percentage of Medicare beneficiaries who have access to a Medicare Advantage plan today (99.9 percent) will have access to a Medicare Advantage plan in 2010. In addition, all Medicare beneficiaries will have many prescription drug plans from which to choose.

The Centers for Medicare and Medicaid Services (CMS) encourages beneficiaries enrolled in Medicare Advantage and Medicare Prescription Drug plans to review their current health and drug plan coverage for any changes their plans may be making for 2010, before the annual enrollment period begins on November 15.

In 2010, beneficiaries who are currently enrolled in Medicare Advantage plans can expect to see an average premium of about $39 a month, a $7 difference from 2009. Medicare Prescription Drug plan premiums will average $30, a $2 difference from 2009. Those who qualify for the full Medicare low-income subsidy will pay no premiums or deductibles in Medicare Prescription Drug plans.

Read more here

Nov 14 – Free Seminar Navigating the Health Insurance Maze for Seniors

Hosted by Austin Groups for the Elderly (AGE). The topic is “Navigating the Health Insurance Maze for Seniors” which will give an overview of the major medical insurance options available to seniors. The seminar will take place Nov. 14 (Saturday), from 10-11.30am in the AGE building at 3710 Cedar Street. For more info or to pre-register, please contact Bruce Kravitz,, (512) 451-4611.

Volunteer Program Targets Medicare Fraud

Thanks to Aging Service Council newsletter for this article.

A few older adults are milling around outside a senior center. Someone approaches them and offers to arrange to purchase scooters for them through Medicare. Because they’ll need physicals before being approved for the scooters-and they’ll need a ride-the person offers to drive them as a group to see a doctor, all for free. After a brief check of their vital signs, the seniors go home. And wait. Sometimes the scooter never arrives, but the Medicare statement does; sometimes a cheap scooter shows up, but Medicare is paying for a really nice one. And someone else, the thief who billed Medicare, pocketed the difference.

The double-whammy here is that these seniors have given out their Medicare ID number, so they risk getting a statement for other services they didn’t request and having their identity stolen.

This is one of dozens of scenarios in the world of Medicare fraud. Considering that Medicare provides health insurance to around 44 million elderly and disabled beneficiaries, it’s a daunting task to alert seniors about what’s happening and how to prevent it.

But that’s just what thousands of SMPs are doing. SMPs are senior volunteers-4,685 in 2008-around the country who are working to educate their peers on how to avoid, detect, and prevent fraud, waste, and abuse that occur all too frequently in the Medicare and Medicaid programs. SMPs give presentations in the community, exhibit at events such as health fairs, answer calls to the SMP help lines, and do one-on-one counseling. They teach beneficiaries how to protect their personal identity, identify and report errors on their health care bills, and recognize deceptive practices. When fraud is discovered, SMPs refer it to the next level of investigators.

Click Here to read the full article

News: Medicare System Overhaul Proposed by Two Senators

Published: April 30, 2009
New York Times

WASHINGTON — Leading senators from both parties said Wednesday that they would make sweeping changes in Medicare to reward or penalize doctors, hospitals and nursing homes according to the quality of care they provided.

The proposals, the opening salvo in a broad effort to overhaul the health care system at the urging of President Obama, would also create strong financial incentives for doctors and hospitals to coordinate the care they now provide in a fragmented way.

The White House and Congressional Democrats have stacked the deck for Mr. Obama’s health plan by making sure it is filibuster-proof. Despite their objections to such expedited procedures, Republicans continue working with Democrats in the Senate Finance Committee.

On Wednesday, the chairman of the panel, Senator Max Baucus, Democrat of Montana, and the senior Republican, Charles E. Grassley of Iowa, unveiled a set of detailed recommendations intended to slow the growth of Medicare, hold doctors and hospitals more accountable, and improve the care of patients with chronic illnesses.

Mr. Baucus said the changes in Medicare could be an engine driving a “transformation of the health care delivery system.”

The story continues here