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From Health Law Daily, October 15, 2013

CMS Medicare update for 2014 explains enhanced benefits

By Michelle L. Oxman, JD, LLM

In preparation for the annual open enrollment period, CMS has updated its “Medicare and You” publication to inform beneficiaries of the changes for 2014. Medicare open enrollment period for calendar year 2014 began October 15, 2013 and will continue through December 7, 2013.

No marketplace involvement. CMS emphasizes that the Medicare is unaffected by the new health insurance marketplaces, also called exchanges. The marketplaces established under the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) serve uninsured individuals who are not eligible for Medicare. Rather, Medicare beneficiaries should use the Medicare Plan Finder.

Enhanced benefits. Beginning in 2014, Medicare will cover an annual consultation with a primary care physician. The first of these visits may be the “Welcome to Medicare” exam; if a beneficiary already has undergone the Welcome exam, the annual visit must occur at least 11 months afterward. In addition to the recommended screenings for cancer, heart disease and diabetes, the annual examination may include screenings for depression, alcohol misuse, and detection of cognitive impairment. Patients may receive a personalized plan for preventive services and a list of their risk factors.

For the first time, Medicare will cover less than a one-month supply of a prescription drug. This will allow beneficiaries and their physicians to test a patient’s response to a new drug or to coordinate the refill dates for all their prescriptions.

Shrinking the coverage gap. In 2014, Medicare beneficiaries covered by prescription drug plans will receive a 50 percent discount on covered brand name drugs when they exhaust the initial level of benefits and reach the “donut hole” of limited coverage. They will pay 47.5 percent of the plan’s cost of these drugs and 72 percent of the plan’s cost of generic drugs, during the coverage gap. If their expenses exceed the out-of-pocket threshold of $4,550 they will have catastrophic coverage for the rest of the year.

Electronic and digital copies. CMS has made this year’s edition of “Medicare and You” available for download onto an individual’s computer and for all e-readers. People who are notified about the publication by email and download it will not receive a print copy.

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