The Madras Pioneer

Doctor's Desk

Consumer Reports publication quite useful

September 07, 2011

When I want to make a major purchase, like a car or appliance, I turn to Consumer Reports to help me compare models, learn safety information and, in general, get the most for my money. But, did you know that Consumer Reports evaluates health care products as well?

For years they have published "Best Buy Drugs" which compares all sorts of medicines to help consumers get the safest, most cost-effective medicines.

More recently, with the passage of the Affordable Care Act, Consumer Reports has published new materials to help us all cut through the whirling dervish of misinformation and to understand the pros and cons of the new health care law.

The first of these publications is "Medicare: Six Things You Need to Know Now." In today's Doctor's Desk I will hit the highpoints of the 16-page booklet. For those who wish to read more, the bulletin is available at http://www.consumerreports.org/health/resources/pdf/MedicareMiniGuide.pdf.

1. Drug discounts -- Before the ACA, Medicare Part D (the drug benefit) allowed seniors with high drug costs to fall into the "donut hole" when they reached a certain dollar limit. The ACA gradually closes this "donut hole." "Starting this year, if you fall into the donut hole you are eligible for a 50 percent discount on brand-name drugs and a 7 percent discount on generics. The ACA will gradually fill the donut hole, fully closing it by 2020.

2. Free preventive services -- If you are enrolled in the original Medicare Plan, starting in 2011, you are eligible for selected free preventive services including an annual wellness exam by your doctor. Medicare Advantage plans are not required to offer these services for free but many do. Services include flu and pneumonia vaccines, bone density testing, smoking cessation counseling and some cancer screening tests. Some patients with certain risk factors are eligible for screening for aortic aneurysm, diabetes, glaucoma and hepatitis vaccines as well.

3. No ceiling on medicare advantage -- Prior to the ACA, there was no limit to what you might owe in co-pays or deductibles. With the new law comes caps on total out of pocket expenses for care provided within your plan's network.

4. Medicare advantage benefits may decrease -- The federal government currently overpays Medicare Advantage plans costing taxpayers and Part B premium payers more money. Starting in 2012, these overpayments will begin to shrink until Advantage plans receive the same amount as original Medicare pays per enrollee. The bottom line for seniors enrolled in Advantage plans is that the plan that works for you now may not be the best for you in future years. Watch for changes in benefits and costs.

5. Those with large incomes may pay more -- For years Part B premiums have been indexed to income. If you earn more than a certain amount, you pay a higher premium. Starting in 2011, Medicare Part D will also be indexed to income. The good news for seniors, however, is that the new health care law freezes this income threshold until 2019.

6. New dates for changing plans -- It is important for you to review your plan now as you can join, switch or drop a Medicare Advantage or Part D plan from Oct. 15 to Dec. 7. There are still some avenues to make plan changes after the first of the year but they become more limited.

Health insurance is confusing -- that hasn't changed -- but there are some significant new benefits that all seniors should know about and take advantage of.

For more information on Medicare changes, contact the Medicare Rights Center at 1-800-633-4227, Nancy Metcalf at Consumer Reports asknancy@consumerreportshealth.org or Oregon's Health Insurance Assistance Program at 800-722-4134.