If You’re Now on Medicare

The new law guarantees that your existing basic benefits will not change, regardless of whether you receive them through traditional Medicare or a private Medicare Advantage plan.

New Part B benefits: Starting in 2011, if you’re in traditional Medicare, you can get an annual physical and many preventive services free. If you’re in Medicare Advantage, check with your plan to see if these will be free.

Part D doughnut hole: If you enter the coverage gap this year, you receive $250 toward your drug costs. Starting in 2011, you get a 50 percent discount on all brand-name and biologic drugs you buy in the gap. Over 10 years, you’ll gradually receive more discounts for generic drugs as well as brands until the gap closes in 2020.

Part B premiums: In the next 10 years more people will likely be required to pay higher-income premiums because the current income levels on which they’re based will be frozen until 2020. Those levels start at $85,000 for a single person or $170,000 for married couples filing joint tax returns.

Part D premiums: For the first time, people with higher incomes (the same as those for Part B above) will pay higher premiums for drug coverage, starting next year.

Medicare Advantage health plans: Medicare currently pays more for people enrolled in many of these private plans than for those in traditional Medicare. The overpayments will gradually be phased out and replaced with a payment system that rewards plans that meet certain quality standards for care and customer service. Also, starting in 2014, plans must spend at least 85 percent of the money they take in from premiums on medical care; and they will no longer be able to charge higher copayments than traditional Medicare for certain services. These changes may prompt some plans to raise premiums, drop extra benefits such as routine vision care and health club memberships, or leave Medicare.

Medigap supplemental insurance: No change. You will not be required to buy a private medigap policy. If you buy medigap insurance outside of the limited time frames when full federal protections apply, insurers can still deny coverage or require you to pay higher rates because of your health and preexisting conditions.

Coverage for people under 65 with disabilities: The two-year waiting period between qualifying for Social Security disability and becoming eligible for Medicare remains unchanged. Early proposals to do away with this delay did not make it into the final law.

Medicare solvency: Cost savings from the new law should keep Medicare financially stable almost a decade longer than if no law had been passed, according to official estimates.

Other Insurance Situations

• If You Receive Employer Insurance

• If You Run a Small Business or Work for One
• If You’re Uninsured or Buying Your Own Insurance

• If You Have a Moderate or Low Income
• Just Where Are Those Savings Coming From?

More Insights About the New Health Care Law


• Five Things in the Law That May Surprise You

• Will My Taxes Go Up?

• Who Must Have Insurance?

• Coverage as Good as Congress’?

• How Will the New Law Affect My Doctors?