Review Medicare Changes for 2010

Review Medicare Changes for 2010

Below is a brief summary of Medicare changes for 2010, including Part A, B and D costs, and a summary of California’s Medicare Advantage and Part D plans for the coming year. More detailed information on Part A and B costs can be found on our updated factsheet, Original Medicare: An Overview (PDF); for detailed Part D information, see our fact sheet, Medicare Part D: An Overview (PDF).

Part I: Summary of Medicare Costs for 2010

Part A

  • Monthly Premium
    • $0 if person or spouse worked 40 or more quarters. Automatic enrollment.
    • $254 if person worked 30-39 quarters. Voluntary enrollment.
    • $461 if person worked fewer than 30 quarters. Voluntary enrollment.
  • SNF Copayment (Skilled Nursing Facility)
    • Days 21 through 100 = $137.50.
Hospital Inpatient Medicare Pays Beneficiary pays
Days 1-60 Everything after deductible $1,100 deductible for Day 1
Days 61-90 Everything after copayment $275 per day copayment
60 Reserve Days Everything after copayment $550 per day copayment
Beyond 150 days Nothing All costs for each day beyond 150 days

Part B

  • Monthly Premium – This amount varies due to there being no Social Security Cost of Living Adjustment (COLA) in 2010. A “hold harmless” provision in the law protects most beneficiaries from having a premium increase when there’s no similar increase in their Social Security checks.
    • For most people (73%), the Part B premium is $96.40.
    • For some people who aren’t protected by the “hold harmless” provision (27%), the Part B premium is $110.50. The categories of people not protected and respective percentage of people in each category include:
      • People with higher income (5%)
      • Dual eligibles (BUT the state pays their Part B premium) (17%)
      • People new to Medicare (3%)
      • People who do not have Part B premiums withheld from their Social Security checks (2%)
  • Premium for Individuals with Higher Incomes (referred to as income related monthly adjusted amount (IRMAA))
    • If a person’s annual income is greater than $85,000 for an individual (filing individual tax return), and greater than $170,000 for a couple (filing joint tax return), their premium will be between $154.70 and $353.60 depending on their actual income amount. See our fact sheet (PDF) for the exact figures.
  • Annual Deductible is $155 (2010).

Part D

Drug costs Beneficiary pays (TrOOP) Plan pays
Before meeting deductible 0-$310 100% = $310 0%
Initial coverage $310-$2,830 25% = $630 75%
Coverage gap (donut hole) >$2,830-$6,440 100% = $3,610 0%
Catastrophic coverage >$6,440 Greater of 5% or $2.50/$6.30 95%

Part II: 2010 Landscape of Plans in California

  • Annual Coordinated Election Period (ACEP)
    • November 15th – December 31st
    • Beneficiaries can make one change or election, effective January 1st

Part D Plans

  • 47 stand-alone Medicare Part D plans are open for enrollment during this year’s Annual Election Period (November 15 to December 31, 2009).
    • See our stand-alone Part D plan chart (PDF) for details on monthly premiums, annual deductibles, coverage during the donut hole, and contact info for each plan.
    • Sanctions on both WellPoint/Anthem and WellCare plans are lifted for 2010.
  • Premiums range from $17.60 to $105.50.
  • 7 stand-alone basic Medicare Part D plans are below the CA benchmark amount ($28.99). If a beneficiary who has the full Low Income Subsidy or Extra Help signs up for one of these 7 plans, he/she does not have to pay a premium or deductible.
  • See our Prescription Drugs section for general info on Part D.

2010 California Benchmark Part D Plans

2009 (6) 2010 (7)
Bravo Rx (same)
First Health Premier (same)
Health Net Orange 1 (same)
Advantage Star (same)
WellCare Classic (same)
NO AUTO-ASSIGNMENT
Medicare Rx (Unicare) (consolidated with NEW Blue Cross Medicare Rx)
n/a NEW Blue Cross Medicare Rx
NO AUTO-ASSIGNMENT
n/a NEW Fox Value Plan

Medicare Advantage (MA) Plans

  • Summary:
    • Local Health Maintenance Organizations (HMOs) are offered in 38 counties.
    • 3 Regional Preferred Provider Organizations (PPOs) are available statewide.
    • Multiple Private Fee-for-Service (PFFS) plans are offered in every county.
      • 3 major plan sponsors no longer offer PFFS plans (Health Net, Coventry/Advantra, WellCare).
    • No Medical Savings Accounts are offered in 2010.
    • Special Needs Plans are open only to those who meet the criteria of the group.
    • ESRD Demo Plans are available in 11 counties.
  • See our MA Plan Landscape Summary (PDF) for more information.
  • See our Medicare Advantage section for more info on MA plans in general.

Part III: Where to Get Help…

Call the Health Insurance Counseling & Advocacy Program (HICAP) for free individual counseling:

  • 1-800-434-0222
  • Find offices by county online
Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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