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
- 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|
- 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).
- The total beneficiary’s true out-of-pocket (TrOOP) costs before reaching catastrophic coverage = $4,550 ($310 + $630 + $3,610).
|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)|
|First Health Premier||(same)|
|Health Net Orange 1||(same)|
|Medicare Rx (Unicare)||(consolidated with NEW Blue Cross Medicare Rx)|
|n/a||NEW Blue Cross Medicare Rx
|n/a||NEW Fox Value Plan|
- See our chart (PDF) of benchmark plans for more info.
- See National Senior Citizens Law Center (NSCLC) publication “Medicare Part D State Fact Sheet 2010: California.”
Medicare Advantage (MA) Plans
- 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:
- Find offices by county online