Medicare - It's Open Enrollment Time For Medicare Advantage And Prescription Drug Plans

Allowing Seniors To Review Options

By Tiffany Rider - Senior Writer

October 23, 2012 – The government sponsored health program Medicare is holding open enrollment through December 7 for qualified applicants or existing clients to review and choose Medicare Advantage and prescription drug plans. Open enrollment began October 15.

According to the U.S. Department of Health and Human Services (DHHS), more Medicare Advantage eligible individuals have a higher number of quality plans from which to choose during this enrollment period.

Compared to traditional Medicare, Medicare Advantage includes both Part A (hospital, skilled nursing facility care and home care) and Part B (routine exams, labs, tests with a primary care physician) coverage at minimum, usually with additional coverage options for dental, hearing, vision and prescription drugs. Medicare Prescription Drug Plan (Part D) is optional.

“In 2013, people with Medicare will have access to a wide range of plan choices, including more four- and five-star plans than ever before,” Kathleen Sebelius, secretary of the DHHS, said in a statement.

In 2013, 127 four- to five-star Medicare Advantage plans will be available. Those plans combined will serve 37 percent of all Medicare Advantage enrollees. In 2012, Medicare recipients had access to 106 plans, serving 28 percent of enrollees.

The number of available four- to five-star prescription drug plans will double to 26 in 2013 from 13 in 2012. Those 26 plans will serve 18 percent of Medicare beneficiaries.

Since the Patient Protection and Affordable Care Act (ACA) passed in 2010, Medicare Advantage premiums have gone down 10 percent and enrollment has risen about 28 percent, according to DHSS. Basic Medicare prescription drug plan premium average is expected to hold the 2012 rate of $30 through next year.

Also during this enrollment period, Medicare beneficiaries enrolled in low-ranked plans will receive report cards to let them know that their coverage was ranked at 2.5 stars or less out of a possible 5 stars. Patients enrolled in plans that consistently under perform, will receive notification of higher-rated plans that they may choose to switch to. Five-star plans are now able to continuously market and enroll seniors throughout the year.

Dave Jones, insurance commissioner for California, recently issued a warning to seniors to be wary of individuals posing as Medicare sales representatives, of which there are none. “Medicare open enrollment is a time when older Californians should be particularly cautious,” he said in a statement. “A growing number of California seniors are falling prey to unscrupulous sales people peddling products seniors don’t need and cannot afford. If it’s too good to be true, it probably is.” The ACA also phases out the coverage gap – known as the “donut hole” – in Medicare prescription drug coverage. The coverage gap occurs when a Medicare beneficiary and his or her drug plan have reached a particular threshold on spending on prescriptions. After that threshold, beneficiaries were required to pay the full cost of the prescription drug up to a certain limit.

According to DHHS, people who reach the donut hole will get 53 percent off the cost of brand name drugs and 21 percent off the cost of generic drugs in 2013. Yearly wellness visits and free preventive services continue.

“I strongly feel that it is valuable for people to review their coverage annually because they could be leaving money on the table,” David Sayen, regional administrator for the U.S. Centers for Medicare & Medicaid Services Region IX in San Francisco, told the Business Journal. “We know people could be choosing a cheaper plan than the one they’re in, and that may not be apparent in the premium because the real cost of the plan is the premium plus the copays and deductibles that you are likely to face based on your health condition and the meds that you need.” Plans do change prescription drug coverage tiers annually, he added.

Sayen described reviewing Medicare coverage options as a cross between filing income taxes and voting.

“The income tax you have to do, and if you do it right you can save money,” he said. “The voting you don’t have to do, but you should do it because it’s a good thing to do. Both of those things require a little bit of homework, and in the case of Medicare, that’s true also. But we have tremendous resources available to people, right down to individual, one-on-one counseling if they want to go to the HICAP (Health Insurance Counseling and Advocacy Program) programs.”

Sayen questioned why beneficiaries or eligible individuals would not take advantage of open enrollment to weigh their options, since the out-of-pocket lifetime projected cost of Medicare is going up all the time and it doesn’t cover everything.

“I know that it can hurt somebody’s head to try to think through it, but that doesn’t make it any less valuable,” he said. “It’s up there along with doing your living will and all the other things that responsible people do.”