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Medicare 2013: Senior Medicare and a Medicare Analysis of Costs

Medicare 2013

The 2013 Medicare costs such as copays and deductibles have recently been released.  Each year, these costs change slightly and most of them will be increasing slightly for 2013:

The standard Medicare B monthly premium will increase from $99.90 to $104.90 (higher income individuals will pay more).

The Medicare B yearly deductible will increase to $147.

The Medicare A hospital deductible (for stays up to 60 days) will be $1184 and the skilled nursing co-pay will be $148/day (for days 21-100, the first 20 days are covered at 100%).

The Medicare A premium for those who must pay a premium (individuals who do not have sufficient quarters of qualifying employment) will actually decrease slightly for 2013.

Check out Aging Wisely’s Medicare 2013 Fact Sheet for all the 2013 numbers and a Medicare analysis of the various pieces of the Medicare program.

In addition to the 2013 Medicare costs, there are continuing changes to Medicare mostly as a result of the Affordable Care Act and healthcare reform.  For example, preventative care coverage has been expanded to cover many screenings.  Medicare recipients can take advantage of the yearly wellness exam to talk with their physicians about recommended preventative care and tests.  Recipients who hit the “donut hole” in drug coverage will receive additional discounts during 2013.  This gap is being phased out altogether by 2020.

Another change that will be coming to Medicare in 2013 is a result of a class action lawsuit, Jimmo v. Sebelius.  The Department of Health and Human Services settled this lawsuit, in which claimants objected to Medicare’s skilled care requirement (for home health and inpatient skilled care) that a patient must show the potential for improvement.  The lawsuit claimed that patients who could benefit from skilled care to manage their current condition or maintain their current functioning should not be denied.

This lawsuit was settled recently and the changes will be rolling out over the next couple of months to providers and consumers.  If you have a claim you feel was improperly denied or questions about current coverage, you can review Medicare’s appeal options or contact us to find out if one of our care managers can help you through the process and with care options.

For our Florida readers (and especially those in the Clearwater/St. Pete, Pinellas County area), another recent news item has potentially big impacts to the healthcare coverage of local residents.  United Healthcare and Baycare Health Systems failed to come to an agreement in negotiations and disputes over payments.  For now, this means that the Baycare system’s hospitals, ambulatory care centers and network physicians are no longer part of United’s networks.  Some patients may use out-of-network providers, typically at a higher cost.  This affects individuals on employer-based plans as well as seniors on United’s Florida Medicare Advantage plans.

Baycare Health System’s physicians have been reaching out to patients to inform them of this situation, so if you are a patient you may have heard the news.  Other individuals who may not be under a Baycare physician’s care, but who may use hospital services, may be less aware of this dispute.  Baycare Health System hospitals include: Morton Plant Mease Hospital, Mease Dunedin and Mease Countryside, Baycare Alliant long term acute care, Morton Plant North Bay in Pasco County, St. Anthony’s and St. Joseph’s (including the Children’s, Women’s and North hospitals) and South Florida Baptist Hospital.

For United Medicare Advantage holders, you may want to consider alternative plan options during the open enrollment periods, particularly if this dispute does not get settled.  The current enrollment period runs through December 7th, and the Medicare Advantage disenrollment period runs January 1st-February 14th.  During the disenrollment period, you can only disenroll from a Medicare Advantage plan back to regular Medicare, but this may be a good option if your key providers are no longer covered under a United plan.  You would need to disenroll and choose a Part D plan for drug coverage.

For help with this issue and a complete Medicare analysis of options and costs, contact us at 727-447-5845 and request a Medicare analysis (or to ask questions about how we can help). 

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