How Seniors Can Prepare for Medicare Open Enrollment


Medicare open enrollment season is just around the corner and beneficiaries who take the time to research different plans and compare prices can find solid coverage at affordable prices.

Starting on Oct. 15 and ending Dec. 7, those about to be or already eligible for Medicare can enroll for the first time in the Medicare Part D prescription drug program or change their existing health coverage.

Open enrollment is the one time of the year enrollees can see what changes are being made to Medicare and change benefits accordingly.

While the Health Care Reform Act will usher in changes in 2013, the Department of Health and Human Services says the average monthly premium for basic prescription drug coverage won’t change next year and will be $30.

According to the HHS, 2013 will mark the year Medicare Part D’s coverage of brand-name drugs starts to increase, which means Medicare participants get 52.5% off those drugs and 21% off the price of generic drugs—up from 14%. The discounts apply to drugs being purchased during the coverage gap, otherwise known as the donut hole.

According to the Center for Medicare and Medicaid, the initial deductible of Medicare Part D will increase by $5, the initial coverage limit will increase by $40 to $2,970 and the coverage gap will start once you’ve reached Medicare Part D plan’s initial coverage limit of $2,970 and ends when you spend $4,750.

Open enrollment is also the time to either enroll in a Medicare Advantage Plan or switch plans. A Medicare Advantage Plan is a health insurance plan funded by Medicare but is offered by private health companies. This type of plan covers all of your Part A which is hospital insurance and Part B which is medical insurance. A lot of the plans also include coverage for things like vision and dental, and most include prescription drug coverage.

With a Medicare Advantage Plan you have to choose doctors and hospitals in the plan’s network and in addition to a monthly premium, you could be on tap for co-payments and coinsurance for covered services.

During the open enrollment months, participants of a Medicare Advantage Plan can change to Original Medicare, switch from one Advantage Plan to another, move to one that offers drug coverage or vice versa, join a Medicare Prescription Drug Plan, switch from one drug plan to another or drop Medicare prescription drug coverage entirely.

There are some additions to the Medicare Advantage Plan. According to the HHS, the average premium is projected to increase $1.47 compared to last year, totaling $32.59.

If members choose lower cost plans at a similar rate as in 2012, the average premium increase is expected to be 57 cents. The HHS noted that 99.6% of beneficiaries will have access to a Medicare Advantage Plan and the number of plan choices will increase 7% in 2013.

Certain preventive benefits like cancer screenings and an annual wellness visit will be covered at no cost. Effective in January, coverage of durable medical equipment (DME) or medical equipment used in the home to improve the quality of life will be limited to preferred manufactures under certain circumstances.

The government advises seniors who are thinking about switching plans or want to know more about how their specific plan will change should review the  "Evidence of Coverage" (EOC) and "Annual Notice of Change" (ANOC), which is sent by the plan each fall. By reading that you’ll know what the plan covers, how much you pay and any changes to the plan that will be effective come January.  Beneficiaries can also go here to compare the costs and benefits of different Medicare plans for 2013.