Medicare, the federal health-insurance program for people 65 and older and their caregivers, is going to see some changes in 2011 thanks to the implementation of new health care laws and there are some changes participants should be aware of during annual enrollment (to Dec 31st) and into next year. The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2011:
Part A: (Hospital Insurance) Premium
- Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
- The Part A premium is $248.00 per month for people having 30-39 quarters of Medicare-covered employment.
- The Part A premium is $450.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Part B: (Medical Insurance) Premium
Most beneficiaries will continue to pay the same $96.40 or $110.50 premium amount in 2011. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2011.
For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs. If your income is above $85,000 (single) or $170,000 (married couple), classified as a Higher-income beneficiary, then your Medicare Part B premium may be higher than $115.40 per month and will be based on the income-related monthly adjustment amount (IRMAA).
Medicare Deductible and Coinsurance Amounts for 2011:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care). For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2011 = $1,132) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:
- A total of $1,132 for a hospital stays of 1-60 days.
- $283 per day for days 61-90 of a hospital stay.
- $566 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
- All costs for each day beyond 150 days
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment) Deductible will be $162.00 per year. You pay 20% (co-insurance) of the Medicare-approved amount for services after you meet the $162.00 deductible.
For those with traditional Medicare , the biggest change on the horizon is an expansion of benefits. Starting Jan. 1, Medicare will completely cover the cost of many preventative services, including mammograms, Pap tests and screenings for prostrate and colorectal cancer, as well as one annual “wellness” examination.
Benefits also will become richer under the Part D prescription-drug program. Currently, these privately managed plans cover 75% of a participant’s drug costs — up to a limit that will rise to $2,840 in 2011. After that, participants fall into a “doughnut hole” gap where they are required to pay 100% of their drug costs until expenditures reach $6,440. Then catastrophic coverage kicks in, capping outlays at 5%. Under the health-care overhaul, the estimated 14% of Part D participants who fall into this coverage gap will start to receive discounts that will reduce the amount they pay — from 100% in 2010 to 50% for brand-name drugs and 93% for generics in 2011.