Welcome Medicare Nation! Everyone keeps asking me about the changes to Medicare for 2016. There are quite a few changes, so today I will focus on the biggest ones you want to know about today.
 
How much will you pay for Medicare Part B (Outpatient Services)?
 
There is no COLA (Cost of Living Adjustment) for 2016. The Hold Harmless Rule comes into play. If there is no COLA, then there can be no increase in Medicare Part B. 
 
For everyone who is already on Medicare and receiving SS benefits, your Part B stays the same at $104.90. That’s 75% of the people that are on it. 
 
If you are turning 65 in 2016 and you are on Medicare, your premium will increase. If you delayed taking SS benefits because you continued working, your premium will increase. If you are on Medicare and Medicaid, your premium will go up. You may qualify for the state reimbursement for Medicaid costs. New premiums will be $121.80. Recommendations were that Medicare Part B premiums should be up around $159, but Congress limited the increase to $121.80. In actuality, Congress gave you a loan for the difference between $121.80 and $159, and charged you a fee for the loan until it can be repaid.
 
Over $65 Billion of Medicare dollars is lost to fraud. Instead of worrying about the fraud, your politicians gave you a loan! Oy Vey!
 
If you make over $85K in income, your premium will increase to a different amount, which you can reference on the website.
 
 
Medicare Part D (Drugs) - Medicare Advantage Plan majority will have drug coverage included already.
 
For 2016, know your deductible situation (max $360). Some have them and you will have to pay out first, and others will only be triggered with a brand name drug.
 
 
The Donut Hole - You don’t want to be in this category. $3310 is the maximum expense for this category. When you add up the amount of money you have paid and the plan has paid, and it exceeds $3310 and now you are in the donut hole. 
 
Now the government wants you to start paying more for your coverage. The new threshold is $4850 for this level. You will now pay 45% of the cost of the brand name drug and you will pay 58% for a generic drug. What you pay out of pocket plus a 50% manufacturer discount. Once you meet $4850, you now fall into the catastrophic coverage phase.
 
Catastrophic Phase - Last through the end of the calendar year. You will pay 5% of the cost of the drug or $7.40, whichever is higher. For generics you pay 5% of the cost of the drug or $2.95, whichever is higher.
 
The slate gets wiped clean as of Jan. 1 and your classification starts all over again.
 
 
Medicare Payout for Providers:
 
For 2016, payments will be reduced by 30%
 
They are looking at tying procedures together when there are multiple issues stemming from the procedure. Payment will be reduced when you are re-admitted to the hospital within a certain timeframe.
 
When a patient contracts an infection during a hospital stay, the payments will also be reduced.
 
They are looking at “Value over Volume”.
 
 
 
If you have been on Medicare for a year, you can have an annual Wellness medicare checkup. This isn’t your annual physical, but a Wellness Medicare Exam.
 
 
From now thru Feb. 14, you can drop your Medicate Advantage Plan and go back to original Medicare and have coverage for Part A and Part B. Then you would need to purchase Part D separately.  
 

No premium for Part A (overnight stays in any type of facility) $1288 is the amount you pay for 60 days. Day 61-90, you pay an additional $322/day and after day 90, you pay $644/day. Every person has 60 lifetime reserve days for one time use only.
In skilled nursing 0-20, 21-100 (max) you pay $161/day.
Part B has a one time deductible of $166, and then 20% of Medicare allowable cost. Find out your co-insurance payment prior to the appointment.

 
Stand Alone Prescription Drugs Plans:
 

All have premiums
Check for the deductibles too
You can apply for a supplement for Medicare to help cover the cost of Original Me