This Act is best known for adding the Medicare Prescription Drug Benefit (due to start in 2006) and the Medicare approved Drug Discount Cards, available now. However, the Act made numerous other changes to the Medicare program. Some were technical corrections. Physicians, Medicare managed care programs and hospitals all got hefty payment increases.
Increases to Part B deductible and premiums.
Annual increases in the Part B deductible, starting with an increase to $110 for 2005.
As of January 1, 2007 Part B premiums will begin to be indexed based on income. There will be a 5 year phase in period. Ultimately, Medicare enrollees with annual income over $80,000 (for an individual) or $160,000 (for a couple) will have a sliding scale for the premium. Those below the threshold will continue to have a premium set to cover 25% of the Part B. costs. The wealthiest enrollees would pay over 3 times as much.
A. Initial preventive physical exam for persons beginning Pt. B coverage on or after 1/1/05.
The “Welcome to Medicare” exam can include influenza and hepatitis B vaccines, mammograms, Pap smears, pelvic examinations and screening tests for prostate cancer, colon cancer, glaucoma, osteoporosis and other conditions. The examination could also include an electrocardiogram, a mental health assessment, hearing and vision tests and a review of the beneficiaries' ability to perform activities of daily living (ADLs) such as bathing, dressing, eating and getting in and out of bed. Doctors should question beneficiaries about their diets, physical and social activities, work histories and use of alcohol, tobacco or illicit drugs. Medicare will cover patient education efforts to address medical problems detected in the examination.
New beneficiaries have to obtain the examination within six months of enrollment.
Coverage is subject to the Medicare deductible and 20% co-payment.
B. Cardiovascular screening tests, including cholesterol and other blood fat (lipid) levels, once every five years.
C. Diabetes screening test (a fasting plasma glucose test) for Medicare enrollees at risk for getting diabetes.
Medicare covers a screening blood sugar test to check for diabetes if you are considered at risk of developing the disease. The major risk factors include any of the following: high blood pressure, dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar. Other risk factors may also qualify you for this test.
Based on the results of the test, you may be eligible for up to two screenings each year.
Medicare covers the diabetes screening test in full.
D. Diabetes Glucose monitors, test strips, and lancets for Medicare enrollees who have diabetes.
Coverage is subject to the Medicare deductible and 20% co-payment.
E. Diabetes Self-Management Training for Medicare enrollees who have diabetes and are at risk for complications from the disease.
Coverage is subject to the Medicare deductible and 20% co-payment.
Changes to the Medicare Advantage (MA) law (Part C, formerly called Medicare+Choice). SeniorChoice, Senior Blue & Encompass 65 are the major local plans. They must provide a Benefit plan equal to Medicare Parts A & B or the actuarial equivalent.
MAP enrollees cannot enroll in Part D. MAP may sell supplemental drug benefits
These plans will face new competition from regional PPOs and MA plans
The Act provides further incentives for Health Savings Accounts (high deductible health plans) including tax incentives and tax benefits to plan sponsors.
Strengthened Medicare Secondary Payer - Medicare will either seek to have another insurer pay, or make conditional payments and seek reimbursement.
