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If I’m nearing 65, what does health care reform mean for me?

Who is this for?

Michigan Health Insurance – Customer Service – Medicare

If you’re enrolled, or are thinking about enrolling in Medicare, this information will help you learn how your coverage will be affected by health care reform.

If you’re nearing 65 years old, you’ve probably done your fair share of Medicare research. What you might not know is how health care reform will affect your coverage in the future. 

You can brush up on the basics at our Medicare 101 page.

Here are some of the things you will enjoy about Medicare under health care reform.

Selecting your own doctor
Medicare-covered benefits
Affordable prescription drug coverage
Wellness exams
Tobacco use cessation counseling
Health screenings

You'll still be able to select your own doctor.

Health care reform won’t affect your options. Visiting health care professionals who participate with Medicare (or who are in your network, if you have a Medicare Advantage Plan) will save you money.

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Your Medicare-covered benefits won't be taken away.

If you’re enrolling—or you’ve already enrolled—in Medicare, health care reform won’t reduce your covered health care services. 

If you’re enrolled in a Medicare Advantage Plan, your benefits might change in the coming years depending on the plan you’ve selected. You can always change your plan during open enrollment, which is Oct. 15 through Dec. 7 of every year.

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Prescription drug coverage may be more affordable for you now and in the future.

You’re probably already familiar with the donut hole, the prescription drug coverage gap associated with Medicare Part D. What you may not be familiar with are the other two stages of prescription drug coverage. You can learn about all three stages here.

In 2011, people with Medicare started receiving 50 percent discounts on brand name drugs in the donut hole. They began paying less for generic Part D drugs, as well. Generic drug cost sharing in the donut hole will continue to decrease. Beginning in 2013, the cost of brand-name prescriptions drugs in the donut hole will be even further reduced. 

By 2020, the donut hole will be closed, meaning you’ll only pay 25 percent of the costs of your drugs until you reach the catastrophic coverage threshold, where cost sharing is reduced to either 5 percent of the cost of your drugs or a small co-pay.   

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Wellness exams

If you have original Medicare or Medicare Advantage, your yearly wellness exam is covered without cost-sharing (Part B deductibles or coinsurance) once every 12 months.

If you are new to Medicare, you can receive a “welcome to Medicare” preventive visit within the first 12 months of your coverage. 

These exams are opportunities to talk with your doctor about your medical history and your health habits so you can create plan for your health together. If your doctor performs additional tests or services that aren’t covered preventive benefits, you may have to pay for a portion of those services. 

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Tobacco use cessation counseling 

If you smoke and want to quit, even if you haven’t been diagnosed with a tobacco-caused illness, you can get counseling at little to no cost. 

If you’ve already been diagnosed with a tobacco-related illness, you’ll need to pay the coinsurance and deductible. 

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Health screenings

To detect health issues sooner, more screenings are available without cost sharing.

Here’s what you can expect to be covered:

  • Bone mass measurement
  • Cervical cancer screening, pap smear tests and pelvic exams
  • Cholesterol and other cardiovascular screenings
  • Colon cancer screening
  • Diabetes screening
  • Flu shot, pneumonia shot, and the hepatitis B shot
  • HIV screening 
  • Mammograms
  • Medical nutrition therapy to help people manage diabetes or kidney disease
  • Prostate cancer screening 

If you have a Medicare Advantage Plan with Blue Cross Blue Shield of Michigan or Blue Care Network, these preventive services might already be covered. You can find out more at our Medicare plans page.

If you’d like to learn more about health care reform in general and what it means for you, check out our health care reform page.

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