Examining Medicare Changes in 2011 and Resources for Patients

Medicare’s annual open enrollment period runs from November 15 through December 31, and this time it is particularly important for older adults and their caregivers to start investigating the policy options early. The healthcare reform law mandates a range of changes in Medicare coverage in 2011, and as a result of the new legislation and other factors, there will be significant changes in the coverage plans offered, with some plans no longer available in 2011. There will also be changes in what the available plans charge. While many changes will enhance benefits for older adults, they will also alter the calculus of determining which plan is the best fit for a given individual.

Making it even more imperative that older adults start scrutinizing their choices as early as possible, the Centers for Medicare & Medicaid Services has also shortened the period immediately following open enrollment (after December 31), during which enrollees can change their choices. In the past, this period ran from January 1 through the end of March, but this coming year it will end on February 15. In addition, starting in 2011, beneficiaries will only have the option of switching from a Medicare Advantage plan to traditional Medicare during this period, whereas they used to have the flexibility of switching from one Medicare Advantage plan to another, from traditional Medicare to a Medicare Advantage plan, or vice versa. As for some of the more sweeping changes in coverage, under the healthcare reform law, all Medicare plans must cover the entire cost of annual physical examinations and other preventive care starting in 2011.

Many private Medicare Advantage plans are already offering preventive care at no additional cost, so the reform mandate means that similar preventive coverage will also be available through traditional Medicare in 2011. Many Medicare Advantage plans have traditionally offered extras, such as vision and dental coverage, but these extras may not be as widely available in the future. Under the new healthcare reform law, most of the government subsidies that the private plans have received will be frozen at current levels in 2011 and phased out by 2017. It is possible that some plans may cut back on extras, so seniors and their caregivers should check whether this coverage has changed as well. The reform law also requires that Medicare Advantage plans cap enrollees’ out-of-pocket expenses, with the “maximum out-of-pocket” limited to $6700. While the new healthcare law won’t close the Medicare prescription drug coverage “doughnut hole” completely until 2017, all beneficiaries who fall into the gap this coming year will get a 50% discount on brand-name drugs and a 7% discount on generics. This applies to those enrolled in both traditional Medicare and Medicare Advantage plans. Informing your patients and their caregivers that there will be significant changes in Medicare next year, and urging them to start sizing up their options now, will help them find the Medicare plan that best meets their needs. For those who are new to Medicare, the American Geriatrics Society Foundation for Health in Aging has published Making Sense–and Making the Most–of Medicare, which provides an introduction to Medicare.

This guide to Medicare is available online, and it may be copied and distributed at no charge. Additional sources that may be useful to beneficiaries include Medicare’s interactive, user-friendly Website (www.medicare.gov). The site includes a Compare Drug and Health Plans tool that enables beneficiaries to compare the cost and coverage offered by each plan in 2011. The site’s Formulary Finder, updated with 2011 data, allows users to enter their medications and receive a listing comparing drug costs and coverage between the available plans. The site also provides a Help with Medical and Drug Costs page, which includes information on financial assistance with Medicare cost-sharing. State health insurance counseling and assistance programs can also help beneficiaries and their caregivers compare plans, at no cost, as can staff at local area agencies on aging. Older adults can find the agency office nearest to them by visiting www.n4a.org or checking their phone book’s blue pages. The Medicare Rights Center (www.medicarerights.org), a nonprofit organization, can help beneficiaries apply for financial assistance to meet some or all of their copays and other out-of-pocket expenses.