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Vol. 14, Issue 1  • January 12, 2015

What’s new in 2015?

Dear Marci,

Can you give me a brief summary of any major changes to Medicare in 2015? I have read information in a few different places, but I want to make sure I am not missing anything at the start of the New Year.

- Ruth (Wilmington, DE)

Dear Ruth,

In 2015, Medicare benefits and costs will remain stable, although some small changes occurred when the year began. For example, Original Medicare costs mostly stayed the same. For Part B, the monthly premium and deductible will remain the same in 2015. You can expect to continue paying $104.90 per month for your Part B premium. The deductible remains at $147. Additionally, if you pay a higher Part B premium due to income adjustments (called IRMAA), these premiums remain the same as well.

For Part A, most people do not need to pay a monthly premium because they have or their spouse has worked in the United States for 10 years or more. If you have worked in the U.S. for 7.5 to 10 years, you pay a premium of $224 per month for Part A in 2015. If you have worked in the U.S. for less than 7.5 years, you pay a premium of $407 per month for Part A. The Part A deductible is $1,260 in 2015. Once you meet this deductible, days 1-60 spent as a hospital inpatient in each benefit period still have a $0 copayment in 2015. Remember, a benefit period begins the day you enter the hospital as an inpatient. It ends when you have not received inpatient hospital or skilled nursing facility care for 60 days in a row. Days 61-90 as a hospital inpatient have a daily copayment of $315. Your copayment during your 60 lifetime reserve days is $630. Remember, these days can only be used once in your lifetime; they are non-renewable.

It is important to know that to the costs listed above relate to Original Medicare. Medicare Advantage plans can change their premiums, copayments, and deductibles, as well as their plans, from year to year. If you have a Medicare Advantage plan, confirm your cost sharing amounts for 2015 directly with your plan. Remember, your Medicare Advantage plan’s networks and list of covered drugs (formulary) may have changed in the new year as well. You should also confirm these changes with your plan. If you find that you are dissatisfied with any changes in your Medicare Advantage plan for 2015, you can use the Medicare Advantage Disenrollment Period (MADP) to switch to Original Medicare with a stand-alone Part D plan. Going from a Medicare Advantage plan to Original Medicare with a stand-alone Part D plan is the only change you can make during this time. Remember, the Medicare Advantage Disenrollment Period occurs each year from January 1 to February 14.

As with Medicare Advantage, make sure you understand any other changes to your Part D plan’s costs, pharmacy networks, and formulary. Contact your plan directly to get their information. If your plan changes its coverage of a drug you took in 2014, it must provide you with a 30-day transition supply of this medication during the first 90 days of 2015.

In 2015, your costs and coverage for your Part D plan may have changed. Medicare beneficiaries with Part D plans pay less in 2015 when they hit the coverage gap, also called the doughnut hole. In 2015, you enter the doughnut hole after your total drug costs reach $2,960. In 2015, once you are in the doughnut hole, you pay 45% of the cost for brand-name drugs, and 65% of the cost for generic drugs. You exit the doughnut hole and enter catastrophic coverage once you have spent $4,700 in out-of-pocket costs. Remember, the Affordable Care Act is closing the doughnut hole in Medicare Part D plans and ensures that beneficiaries pay no more than 25 percent of the costs of their prescription drugs throughout the year by 2020.

-Marci

Health Tip
A new report from the American Cancer Society has found that due to early detection tools and other preventive health measures, the cancer death rate has fallen 22 percent over the past two decades—meaning roughly 1.5 million lives have been saved. Encouraging Americans to quit smoking has played a significant role in reducing cancer deaths; the number of smokers has been cut in half, which has cut down on lung cancer death rates. Additionally, the increased use of early detection screenings like mammograms and colonoscopies has helped decrease cancer deaths. Men were also found to have a greater annual decline in cancer death rates (1.8 percent) than woman (1.4 percent).

To read a summary of the report from HealthDay News, click here. To read the full report from the American Cancer Society, click here.

Medicare covers several cancer screenings at full cost under the preventive care benefit, including mammogram screenings, prostate cancer screenings, and colon cancer screenings. For a full list and explanation of the preventive care services covered by Medicare, click here.

Need to Know
The Medicare Advantage Disenrollment Period occurs each year from January 1 to February 14. If you are enrolled in a Medicare Advantage plan for 2015 and are dissatisfied with the plan or its changes, you can use the Medicare Advantage Disenrollment Period to switch from your Medicare Advantage plan to Original Medicare, with a stand-alone Part D plan.

You can only switch from a Medicare Advantage plan to Original Medicare during the Medicare Advantage Disenrollment Period. To make this change, you can contact 800-Medicare.

Dear Marci is a biweekly e-newsletter designed to keep you — people with Medicare, social workers, health care providers and other professionals — in the loop about health care benefits, rights and options for older Americans and people with disabilities.

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