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What’s New in Medicare

It’s important to stay informed about Medicare updates and changes that may affect your coverage.

Here is a quick summary of recent Medicare updates and changes.

Part B premium and deductible amounts stay level

  • Most people will pay a Part B premium of $104.90 and a deductible of $147 in 2015. These are the same amounts that Medicare charged in 2014.
  • People with higher incomes may pay higher Part B premiums. the most that may be paid in 2015 is $335.70. This amount is unchanged from 2014.
  • The Part A deductible rose to $1,260 for 2015. It was $1,216 in 2014.
  • The Part A premium, if you pay it, actually went down from $426 in 2014 to $407 for 2015. for most people, Part A is premium-free.

Some Part D plans introduce split-tier deductibles

  • In a tiered formulary, drugs on different tiers carry different out-of-pocket costs. Usually lower-tier drugs cost less.
  • Plans with deductibles have generally applied the deductible to all covered drugs. Once the deductible was met, the plan started paying some of the cost for drugs.
  • With a split-tier deductible, plans may charge a deductible for drugs on some tiers and not on others. Or the plan may charge one deductible amount for drugs on some tiers and a different deductible amount for drugs on other tiers.

Medicare expands some coverage and services

  • Medicare's Blue Button allows you to get access to your personal health information. You can download 12-36 months of claims information for Part A and Part B. You can also get 12 months of claims information for Part D. Visit MyMedicare.gov to use the blue button.
  • Blue Button users also have access to health applications and services to help analyze their health information. Visit bluebuttonconnector.healthit.gov to learn more.
  • Medicare covers several preventative tests and exams, including a new non-invasive colorectal cancer screening called a fecal occult blood test. Discuss screening options with your doctor.
  • Mental health care is now covered at the same rate as other medical services. You pay 20% of the Medicare-approved amount, as long as the provider accepts Medicare assignment.

Health exchanges may have little impact on Medicare beneficiaries.

  • Most Medicare beneficiaries are not directly affected by the new Health Insurance Marketplace (also called health exchanges) established by the Affordable Care Act of 2010.
  • You will continue to get your health coverage through Original Medicare or a private Medicare plan.
  • Individuals who are not on Medicare and whose employers do not offer health insurance can shop for and compare plans in the Marketplace.
  • The Marketplace includes the federal and several state-run health exchanges. Your state may have its own exchange or it may participate in the federal exchange.
  • Individuals who buy health insurance in the Marketplace and later become eligible for Medicare need to pay attention to timing when transitioning to Medicare to avoid gaps in coverage and potential enrollment penalties.

Bigger discounts on prescription drugs during the coverage gap

  • The Medicare Part D coverage gap continues to shrink. Your cost-sharing percentage for prescription drugs during the gap is less each year compared to the year before, until the gap closes in 2020.
  • In 2015, you will pay 65% of the total cost for generic drugs or 45% of the total cost for brand–name drugs during the coverage gap. You may pay less if your private Medicare plan has additional coverage during the gap.

5-Star Special Enrollment Period

  • If one is available in your area, you can switch to a 5-star Medicare Advantage plan through November 30, 2015.
  • If your current Medicare Advantage plan includes drug coverage and you switch to a 5-Star Medicare Advantage plan that doesn’t, then you won’t be able to get drug coverage until the next Open Enrollment Period. You also may have to pay a penalty.
  • You can only use this Special Enrollment Period one time each year.
  • You can read about Medicare’s Star Ratings at Medicare.gov.