Medicare Watch

Medicare Rights Releases Resource on Enrollment

Today, Medicare Rights Center released a comprehensive informational packet that explains upcoming changes to the Medicare program. Consumers need to be aware of these changes in order to make decisions about coverage during the upcoming Fall Open Enrollment Period. Intended for journalists, but useful for advocates and consumers, the packet includes an explanation of the new Medicare Advantage Disenrollment Period (MADP), which will take place from January 1 to February 14 each year. During the MADP, people in Medicare private health plans, also known as Medicare Advantage plans, can disenroll from their plans and enroll in Original Medicare. The packet also explains the difference between consolidation and termination of Medicare Advantage plans and Part D prescription drug plans. Furthermore, the packet provides information on the 50 percent discount on brand-name drugs and 7 percent discount on generics that consumers will receive during the Medicare prescription drug coverage gap in 2011. The closure of the coverage gap was made possible by the Affordable Care Act (ACA), which was passed earlier this year. The packet includes links to useful tools such as Medicare Interactive, Medicare Rights’s consumer-friendly website that provides answers to Medicare questions, and fliers on new benefits and changes that can be easily printed and distributed.

Fall Open Enrollment begins on November 15 and ends on December 31 of this year. During Fall Open Enrollment, people with Medicare are allowed to make as many changes as they want before December 31, and the last change they make will take effect on January 1, 2011. With plan options already available for review on Medicare.gov’s online Plan Finder tool, it is important that consumers are aware of changes to the Medicare program so that they may choose the coverage option that is best for them.

Read Medicare Rights Center’s Fall Open Enrollment Resource.

Report Discusses Changes to Medicare Private Health Plans in 2011

In 2011 there is a substantially smaller increase in premiums for Medicare private plans offering drug coverage (also known as Medicare Advantage plans with drug coverage, or MA-PDs), according to the Medicare Advantage 2011 Data Spotlight, released by the Kaiser Family Foundation this month. The premium calculations were weighted by 2010 enrollment. While there was a 22 percent increase in weighted premiums for MA-PDs between 2009 and 2010, there was a modest five percent increase between 2010 and 2011. When premiums are not weighted by 2010 enrollment, there is a five dollar decrease in premiums from 56 to 51 dollars. This means that Medicare consumers in MA-PDs that have a premium increase in 2011 should explore other available options in their area, because a lower-cost alternative may be available.

Medicare consumers will have, on average, 24 Medicare Advantage plans from which to choose, and 88 percent of consumers will have access to 10 or more plans in their county in 2011.

The Spotlight also covers changes to the Medicare Advantage program, including improvements included in the Affordable Care Act (ACA), such as the new requirement that all plans include a Mandatory Out-of-Pocket Limit (MOOP), and limitations on cost-sharing for high-cost services such as chemotherapy and renal dialysis. Lastly, the Spotlight discusses other changes to the program, including consolidation of Medicare Advantage plans offered by the same sponsor that had duplicative benefit and coverage structures, and the drop in the number of private fee for service plans (PFFS) as a result of new requirements resulting from the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

Read the Kaiser Family Foundation’s Medicare Advantage 2011 Data Spotlight.

Dear Marci,

Which drugs does the Medicare drug benefit cover?

— Steve (Blanchardville, Wisconsin)

Dear Steve,

Each Medicare prescription drug plan has its own formulary, or list of covered drugs. A Medicare drug plan generally will help pay only for drugs that are on its formulary and that you buy at a pharmacy in the plan’s network.

If the drug you need is not on your plan’s list of covered drugs, as long as the drug is not excluded from Medicare coverage by law, your doctor may be able to ask for an “exception” to have your plan cover it.

Learn more about Part D on www.MedicareInteractive.org.

The excerpt above is adapted from Dear Marci, our biweekly newsletter for consumers. Sign up for Dear Marci.

Spotlight

AARP has released a video on the upcoming Fall Open Enrollment Period. The video provides practical advice and encourages consumers to explore their coverage options.

Watch the video.