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Sayen: What’s new in Medicare for 2013

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davidsayen
David Sayen is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada and the Pacific Trust Territories. Courtesy photo.

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 percent for covered brand-name drugs and 79 percent 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 percent 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 one-time “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).

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KDude
aluchsing
written by KDude, January 19, 2013
Spoken like a true right wing nut!smilies/wink.gif
ca215
@ramcc
written by ca215, January 04, 2013
You posted MY question before I got a chance to rant about Ah-Nahld's last "I hate poor people" actions before he skipped out the door of the Gov's residence for the last time.
I hear it is possible, ramcc & guest, to beg a dr for dental or vision help and maybe get attention paid to vision or dental care IF great god Medicare honchos agree. For instance, if a person falls repeatedly, hits his/her head so often that vision if afflicted that problem might get some attention. Key word there is "might." If the patient can read adequately by closing one eye which, by the way, really screws with depth perception but drs don't worry much about that; the person probably is not driving a car while reading. I don't know if glancing one-eyed at a map is classed as "reading." Guess that's for the drs and Medicare geniuses to figure out...

If a Great Dane decides that dentures put to soak in a cup of denture cleaner are a great chew-toy and destroys either top or bottom faux teeth, will Medicare allow a replacement? Don't bet on it. It won't allow a person who uses dentures to get a plate relined when it needs to be. Medicare heads seem to not understand that a person who cannot eat properly because his or her teeth are in need of a reline will suffer impacted health.

So, will Medicare agree that treatment of the effects of improperly fitting teeth is necessary or will it say "Well, you will have to pay out of your own pocket for the reline you claim you need. Have a nice day." The next thing the person begging for attention to the fakes will hear is the hang-up click of Medicare agent's phone. Where is the person supposed to get the huge amount of $$$$ to hand over to a dental student who might do a proper job of relining the person's teeth?

I happen to know a woman who fell repeatedly, broke bones in a foot that were not tended to as they should have been. That foot will never be right. Her primary doc and the foot-fixer don't give a D***.
She fell again and again, with the result that many "natural" teeth were destroyed. She got no attention from Medicare because MCare doesn't care if teeth are snaggle-broken or completely broken off at the gum-line, requiriing replacement by plastic things that look like teeth. The replacements she got didn't fit properly so she had to go back to inept dentist, have the things adjusted and hope to not have to go back AGAIN for more "adjustment" work..
Several dental appointments later after her credit cards were maxxed out because she had to try to pay the huge bills for being knocked out and having the useless teeth replaced by dentures.

It seems to not matter to the rulers that even though orthopedic and dental experts supposedly did their best to fix the problems caused by falls but the supposed repairs were not right. So what if she can't walk farther than one block without suffering incredible foot pain, if she's reduced to eating soup and nothing more stubborn than mushy rice? What's left of her health will take a dive because she cannot eat properly. You think Medicare will allow her to get real help with the dental issues? Don't bet on it...

It seems poor or health-challenged people are not dying off as fast as the rulers would prefer. Hold on, everyone who might be reaching for a keyboard in order to call me paranoid. Do some reading first. Check out, for instance, a tourist-trapping monstrosity called "The American Stonehenge." Engraving in that thing dictates the number of people allowed to remain alive --- in the whole world. Then see if I still sound paranoid. If the engraved words there don't at least make a reader pause to think for a few seconds that reader might want to check his/her pulse.
aluchsinger
...
written by aluchsinger, January 03, 2013
Also, are you suggesting that we get rid of the profit motive in healthcare?
aluchsinger
...
written by aluchsinger, January 03, 2013
When you say "affordable",who's paying the difference? How are high costs being addressed by these new laws?
Greg_Cornish
Some comparison.
written by Greg_Cornish, January 03, 2013
I'd rather look at affordable health care, not free. I'd rather look at models like the U.K., France and Canada. I've talked to the citizens that benefit from those nation's health care. They have a bigger satisfaction rate than we do. We can improve upon their systems if we get rid of astronomical profits associated with illness. If you feel those countries are socialist, you never name them. You prefer to use countries like the Soviet Union which was communist under ruler class parties as your examples.

I just went through Mayo Clinic this year wanting surgery and was subject to $37,000 for 11 tests over a one and one half month period where I had to stay away from home. I was later, through bending a few arms, allowed into the Stanford system who earlier refused my workers comp insurance. They said most all the tests at Mayo Clinic were unnecessary. There, surgery cost $37,000 and 9 days recuperating in the hospital was $375,000. When all was said and done with a surgical procedure that took 3.5 hours my insurance was billed nearly $1/2 million and I has to wait at deaths door for 6 months.

My heart skips a beat when I hear healthy conservative say, "We have the greatest healthcare system in the world."
aluchsinger
...
written by aluchsinger, January 02, 2013
Capitalism and charity will maximize prosperity in a society. Socialism will certainly minimize prosperity over the long run. Both have been proven by history many a time.

We need to address the issue of high costs. Competition and direct payment would go a long way to get started.

How about being able to purchase insurance across state lines? And how about more HSAs? The new laws make both of these things more difficult.

You want a glimpse of our free healthcare society 50 years from now? Look at America'a Indian reservations.
Greg_Cornish
@ aluchsinger
written by Greg_Cornish, January 01, 2013
Capitalism doesn't work for people who can't afford health care so what political system would you suggest?
aluchsinger
...
written by aluchsinger, December 31, 2012
Why stop at just making drugs "cheaper"? Let's just make everything free. And why stop at seniors? Let's make it free for everyone. And why stop at healthcare? I need other things too.

The voters of this country have an entitlement attitude that is systematically bringing this country closer to socialism. I have news for you:socialism does not work.
tom
ramcc
written by a guest, December 30, 2012
The short answer is no. The only exception is injury to the teeth or gums,or eyes.
ramcc
Does it include...
written by ramcc, December 30, 2012
Dental and Optical care for seniors?

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Last Updated ( Sunday, 30 December 2012 03:28 )