As a geriatrician and someone who works with Medicare beneficiaries every day, I continue to get a lot of questions about how the Affordable Care Act has impacted Medicare.
As we approach the 2016 Medicare Open Enrollment season, which runs from October 15 to December 7, I’d like to point out three notable changes to help you or your loved one feel better prepared when choosing the right Medicare coverage for the year ahead.
First, take advantage of the Affordable Care Act’s preventive care benefits. Medicare now covers services including an annual wellness check-up, obesity screening and counseling and smoking cessation counseling.
I urge every Medicare beneficiary (or caregiver) to take the time to schedule annual wellness visits with his or her primary care physician — a very important step to help manage overall health.
Many important cancer screenings, such as mammograms and colonoscopies, are now covered by Medicare at no out-of-pocket cost.
Second, Medicare beneficiaries will now enjoy more savings in the “donut hole.” In the past, people who fell into Medicare’s prescription-drug coverage gap — or “donut hole” — had to pay the full cost of their medications. Now, the coverage gap is gradually closing, meaning beneficiaries will be able to get their medications at a lower cost when they fall into the coverage gap.
For 2015, the donut hole started once a beneficiary spent $2,960 for covered drugs and ended when out-of-pocket drug costs hit $4,700. For 2016, the coverage gap doesn’t start until a beneficiary spent $3,310 for covered drugs and ends at $4,850.
And, each year for the next few years, beneficiaries will be required to pay less and less until the donut hole is gone in 2020.
Third, take a fresh look at the benefits a Medicare Advantage plan may offer. A Medicare Advantage plan is a private health plan providing Medicare benefits and comes with annual out-of-pocket maximums. Medicare Advantage beneficiaries may notice their plans now offer extra benefits, such as vision, hearing and/or dental coverage, prescription drug coverage or even a gym membership.
Know Your Options
I’ll leave you with one of the most important pieces of advice I can provide: It’s important to know that Medicare plans can change from year to year, as can your health and budget needs.
I encourage Medicare beneficiaries to understand their options so they can make informed and confident decisions about their health care coverage. (There are many resources available to help you navigate Medicare, such as the government’s Medicare.gov site and my company’s site, MedicareMadeClear.com.)
Now is a good time to begin looking into your Medicare options so you can choose the 2016 coverage that’s right for you.