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How Obamacare Will Affect Medicare Recipients in 2013

Here are some changes coming in the new year, writes David Sayen, Medicare’s regional administrator for Arizona, California, Hawaii, Nevada and the Pacific Trust Territories.

By David Sayen

The Affordable Care Act strengthened Medicare in important ways. Signed in 2010, the federal health law already has provided free preventive health benefits to millions of people with Medicare, and saved billions of dollars for those who hit the gap in their Part D prescription drug coverage.

In 2013, discounts on prescription drugs for people who reach the Part D “donut hole” will increase, and Medicare will cover screenings and counseling for alcohol misuse, behavioral therapy for cardiovascular disease, counseling for obesity, and more.

If you reach the donut hole in 2013, you’ll pay only 47.5% for covered brand-name drugs and 79% for generic drugs. Thanks to the Affordable Care Act, these discounts will gradually increase until the hole is closed in 2020.

In 2013, Medicare will cover one alcohol misuse screening per year for adults with Medicare (including pregnant women) who use alcohol, but don’t meet the medical criteria for alcohol dependency.

If your primary-care doctor or other primary-care practitioner determines you’re misusing alcohol, you can get up to four face-to-face counseling sessions per year (if you’re competent and alert during counseling). A qualified primary-care doctor or other primary-care practitioner must provide the counseling in a primary-care setting such as a doctor’s office.

Medicare also will cover one visit per year with your primary-care doctor to help lower your risk for cardiovascular disease. During this visit, your doctor may discuss whether taking aspirin is appropriate for you, check your blood pressure, and give you tips to make sure you’re eating well.  

If you have a body mass index of 30 or more, Medicare will cover intensive counseling to help you lose weight. This counseling may be covered if you get it in a primary-care setting, where it can be coordinated with your personalized prevention plan.

In 2013, Medicare also will cover screenings for chlamydia, gonorrhea, syphilis, and Hepatitis B. These screenings are covered for people with Medicare who are pregnant and/or at increased risk for sexually transmitted infection. Medicare covers these tests once every 12 months or at certain times during pregnancy.

In addition, Medicare covers up to two high-intensity behavioral counseling sessions each year for sexually active adults at increased risk for sexually transmitted infections. Medicare covers this counseling only in a primary-care setting. Counseling in an inpatient setting, like a skilled nursing facility, isn’t covered as a preventive service.

You pay nothing for any of the above services if your primary-care doctor or other qualified primary-care practitioner accepts Medicare’s payment amount.

Medicare now covers one depression screening per year, too. The screening must be done in a primary-care setting that can provide follow-up treatment and referrals. You pay nothing for this test if the doctor or other qualified provider accepts Medicare payment, but you generally have to pay 20% of the Medicare‑approved amount for the doctor’s visit.

Besides these services, Medicare covers a long list of preventive benefits—often at no cost to you—to help you stay healthy and detect disease in its most treatable stages.

Medicare-covered preventive services include tests and screenings for breast, prostate, cervical, and colon cancer; screenings for conditions that may trigger heart attack or stroke; checks for diabetes and glaucoma; and counseling to help you stop smoking.

You’re also entitled to a onetime “Welcome to Medicare” checkup during the first 12 months after you take Medicare Part B, and wellness visits with your doctor each year after that. These visits are free.

Shots to protect you against flu and pneumonia also are free.

The Affordable Care Act eliminated deductibles and co-pays for most Medicare preventive services in order to encourage people to use them more.

Please take advantage of them.

David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii and the Pacific Trust Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

Chris Ziegler December 26, 2012 at 04:21 PM
David, I sure wish you folks would come clean on the tough issues! Especially, now that you don't have to worry about re-election again: More specifically, end-of-life treatment plans/living wills. A medicare financial expert on one of the financial news channels indicated that he suspected, "if everyone just documented their wishes for final care, we would save enough money to balance the federal budget". I believe there is fair consensus among experts that 25% of Medicare funds is spent on people in their final months of life. The suspicion is that most of us would say something to the effect: "When it's my time just make me comfortable" versus the situation now which is, 'without judgment, how can we keep this person alive?'. Would it be too much to ask every American to document their desires so that surviving family members don't have feel like they are making life and death calls for a loved one?
R Terry December 31, 2012 at 10:20 PM
Makes common sense. I have a feeling that people are afraid that the plug is going to be pulled on them for a "stubbed toe" that they could have recovered from. My mom was in that situation years ago at Arcadia Methodist. The doctor proceeded to sternly "lecture us" on the downside of keeping someone alive who was not likely to recover. We politely listened then told him that were not requesting any further measures to keep her going. He immediately "perked up"...

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