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November 9, 2010 > Medicare Changes for 2011 - What You Need To Know

Medicare Changes for 2011 - What You Need To Know

Learn More About Medicare Coverage at Upcoming Seminars

While upcoming changes to Medicare Part D - the program's prescription drug coverage - have received the lion's share of publicity lately, there are other changes to Medicare Part A (hospitalization), Part B (medical insurance) and Part C (Medicare Advantage Plans) coverage coming in 2011.

For example, starting January 1, Medicare beneficiaries will pay nothing for most preventive services from a doctor or other health-care provider who accepts "assignment." Assignment means that the provider has agreed to accept the Medicare-approved amount as full payment for covered services.

To help people learn about the changes coming to Medicare Part A, Part B and Part C in 2011, Washington Hospital is offering a free seminar on Friday, November 19 from 10 a.m. to noon in the Conrad E. Anderson, M.D. Auditorium at 2500 Mowry Avenue in Fremont. (Additional seminars to discuss changes in Medicare Part D are scheduled for Monday, November 15 and Wednesday, November 17 from 10 a.m. to noon in the auditorium.)

"It's important for people to understand the changes coming in 2011," says Linda Dawal, Health Insurance Information Service Coordinator for Washington Hospital. "Many changes apply to providers who accept assignment. Some providers don't accept assignment, but in 2011 various Medicare supplement policies - also known as 'Medigap' - will pick up the entire cost of what Medicare doesn't cover for Part B. Medigap policies, which are sold by private insurance companies, cover costs like co-payments, co-insurance and deductibles."

Some of the changes to Medicare Part B coverage for services offered by providers who accept assignment that will take effect January 1 include:

* If you have had Part B for longer than 12 months, you can get a free yearly "Wellness" exam to develop or update a personalized prevention plan based on your current health and risk factors.

* Medicare will cover a "Welcome to Medicare" exam if you get it within the first 12 months you have Part B. Your first "Wellness" exam cannot take place within 12 months of the "Welcome to Medicare" physical exam.

* With a physician referral, a one-time ultrasound screening for abdominal aortic aneurysm will be provided as part of the "Welcome to Medicare" exam for people at risk.

* A bone density screening will be covered once every 24 months (more often if medically necessary) for people who have certain medical conditions or meet certain criteria.

* Medicare will cover screening mammograms once every 12 months for women 40 and older, and one baseline mammogram for women between ages 35 - 39.

* If your doctor refers you for the service, Medicare may cover medical nutrition therapy and certain related services if you have diabetes or kidney disease, or if you had a kidney transplant in the last 36 months.

* In addition to providing free Pap lab tests (once every 24 months, or once every 12 months for women at high risk), Medicare will completely cover Pap test specimen collection, as well as pelvic and breast exams.

* Medicare will consider smoking cessation counseling as a covered preventive service, even if you haven't been diagnosed with an illness that is caused or complicated by tobacco use.

Another major change to note is that people who are in a Medicare Advantage Plan (Part C) will be able to leave their plan and switch to Original Medicare between January 1 and February 14, 2011. People who switch to Original Medicare during this period will have until February 14 to also join Medicare Part D to get prescription drug coverage. (During this period, you cannot switch from Original Medicare to a Medicare Advantage Plan or from one Medicare Advantage Plan to another.)

"People who are considering switching from a Medicare Advantage Plan to Original Medicare absolutely should add Part D prescription coverage," Dawal cautions. "Also, you should recognize that you may be taking quite a chance with your health coverage because you may not qualify for Medigap insurance if you have pre-existing conditions."

Washington Hospital's Health Insurance Information Service offers free, unbiased counseling on health insurance, including Medicare, Medicare Advantage Plans and Medigap insurance.

"We don't want people to be taken for a ride and talked into a plan that's not right for them," Dawal says. "Don't ever sign up for a plan you don't understand."

To register for the seminar on November 19 regarding changes in Medicare Part A, B, and C or one of the seminars on changes in Medicare Part D on November 15 and 17, visit or call (800) 963-7070. For more information bout the Health Insurance Information Service, call 800-770-9447.

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