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Changes in Medicare for 2012

Medicare will cover more preventive services this year and seniors who are on the drug plan can look forward to a price break in the program’s infamous “doughnut hole,” a gap in prescription drug coverage.

Among the major changes for 2012:

For those with “Original” Medicare, i.e. those without a Medicare Advantage Plan, more preventive services now are covered at no cost, said Bob Moos, a public affairs officer for the Centers for Medicare and Medicaid Services. The changes include screenings for cardiovascular disease and obesity, Moos said, specifically coverage for a doctor’s visit each year to help stave off heart problems and a free screening for obesity.  For those with a body mass index of 30 or higher, the free screening includes regular counseling sessions at a doctor’s office. Patients who lose at least 6 pounds during the first six months qualify for six more months of counseling.   The cardiovascular screening includes a check for hypertension and discussions of diet and how it can lower the risk of heart disease or stroke.  “In the past, there were a lot of preventive services where Medicare paid 80 percent of the cost, and then the person on Medicare would pick up the remaining 20 percent,” Moos said. “But as a result of the Affordable Care Act, many of these preventive services became free to the senior.”

Other free services include cancer screenings, colonoscopies, mammograms and other, similar screenings that can help find illness “at an early stage when it’s most treatable,” Moos said.  Generic drugs get a bigger price break in the program’s “doughnut hole,” a coverage gap that starts after the Medicare recipient and the drug plan have spent a certain amount for covered drugs.   In 2012, the initial coverage limit is $2,930. The “hole” closes after recipients spend a total of $4,700.   “In the past, typically when someone falls into the doughnut hole, they have been responsible for the full price of their drugs,” Moos said. “But again, thanks to the Affordable Care Act, that is changing.”  Starting last year, Medicare D patients got a 50 percent discount on covered name brand drugs, Moos said.  While that stays the same this year, the discount on generic drugs bumped up to 14 percent in 2012, up from 7 percent last year.  Monthly premiums for the part of Medicare that covers doctor visits and outpatient hospital services will increase for most people by $3.50, Moos said, making them $99.90 in 2012.   “That’s an out-of-pocket people pay attention to on a year-to-year basis,” Moos said, noting that such premiums are typically deducted from Social Security checks.

Other changes for 2012 include:

The ability to assess hospitals, nursing homes, home health agencies and other health care providers via Medicare’s new “Quality Care Finder” (  The improved online tool describes the quality of care at specific facilities, such as how well a hospital protects outpatients from surgical infections and what steps a home health agency takes to manage pain, treat wounds and keep patients safe, according to information from Moos.  Certain doctors and hospitals now are working more closely with Medicare to help people with chronic conditions, such as diabetes and high blood pressure, get the care they need to stay out of the hospital.  Part of that new program’s goal is to stave off unneeded tests and procedures.

(Brian Bethel is a reporter for The Abilene Reporter-News in Texas

Copyright 2012 Scripps Howard, Inc.
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