Senior Living: Medicare and health-care reform

Q. What are the major changes to Medicare due to health-care reform?


To refresh your memory or for those new to Medicare, Medicare's Part B is out-patient visits, Part D refers to drug plans and Medicare Advantage plans are HMOs. Among the changes that take effect in 2011 are these:

•Part D participants receive a 50% discount on brand-name drugs and a 7% discount on generics when they are in the Part D coverage gap, also known as the "donut hole."

•All beneficiaries with Medicare Part B are entitled to a free wellness exam once a year which is not subject to the Part B deductible ($162 in 2011). This is in addition to the free "Welcome to Medicare" physical exam beneficiaries can receive during their first 12 months of Medicare coverage.

•Beneficiaries with Medicare Part B have no cost-sharing for a wide range of preventive services.

•All Medicare Advantage plans have a new mandatory maximum out-of-pocket limit for their plan enrollees.

•The former Medicare Advantage Open Enrollment Period (OEP) is replaced by the new Medicare Advantage Annual Disenrollment Period (ADP), which is from Jan 1 to Feb 14 each year.

•Medicare Part D enrollees with higher incomes pay a higher premium for their Part D prescription-drug benefits.

•The income limits over which people pay higher Part B, and this year Part D, premiums are no longer indexed for inflation. Instead, they are frozen at 2010 levels from 2011 through 2019. As incomes rise over time, more people will have to pay the higher premiums.

NANCY TURNEY received a bachelor's degree in social work and a certificate in gerontology. If you have a specific question you would like answered in this column, e-mail it to or call Turney at the Crescenta-Cañada YMCA, (818) 790-0123, ext. 225.

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