With Senior Health Insurance Open Enrollment, seniors have opportunity to change, modify or enroll in Medicare benefits for an extended period of time. In 2011, mandatory enrollment period begins October 15th and extends through December 31st. At this time, qualifying applicants will either select a Medicare package that is right for them or make changes to their existing packages.
What Actions Can I Perform During Senior Health Insurance Open Enrollment?
- Patients may change from an Original Medicare Plan to a Medicare Advantage Plan.
- Patients may change from a Medicare Advantage Plan to an Original Medicare Plan.
- Patients may select a different Medicare Advantage Plan than the one they currently have.
- Patients may select a Medicare Advantage Plan that does offer a prescription drug Plan if their current plan does not offer a prescription drug plan.
- Patients may opt to cancel their prescription drug plan that accompanies the Medicare Advantage Plan if they currently have a prescription drug plan.
- Patients may join a Medicare Prescription Drug Plan three months before their 65th birthday or three months after their 65th birthday. Alternatively, during open enrollment, any senior can change, join or cancel a Medicare drug plan.
- Patients may select to change from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
- Patients may elect to cancel their Medicare Prescription Drug Plan.
How Has Medicare Changed?
In 2010, Medicare lowered prescription drug costs, added wellness checkups and additional preventative care services. In 2011, the Affordable Care Act announced that cost-sharing expenses for mammograms, glaucoma tests, prostate cancer screenings and numerous other wellness checkups would be eliminated. Instead, Medicare will pay for annual check-ups, a physical examination and a comprehensive risk assessment. Seniors may also receive a personalized prevention plan.
Seniors are now eligible for coverage of their drugs up to $2840 after paying a $310 deductible. After the $2840 is reached, Medicare will cover 50% of the cost of brand name prescription drugs. This gap or lapse in coverage is often referred to as the “donut hole.” Additional discounts may also be given on brand name and generic prescription drugs.
After the patient reaches $4,550 out of pocket, the cost for prescription drugs will resume with a small co-payment. The Affordable Care Act, in 2010, will provide a $250 rebate for expenses in the coverage gap. By 2020, Medicare hopes to close the gap and only require the patient to pay 25% of the costs for prescription drugs.
Seniors enrolled in the Advantage Plan will have increased premiums, and Medicare Advantage Fee-for-Service Plans will no longer be available.
What Does Medicare Cover?
Medicare is designed for seniors age 65 and older. There are four parts of Medicare coverage: Part A, Part B, Part C and Part D.
Part A – Hospital Insurance. Part A is free for most enrollees that have worked a significant portion of their lives and paid Medicare taxes. This portion covers inpatient hospital care, admittance to a skilled nursing facility, hospice or home health care.
Part B – Medical Insurance. Part B covers medically necessary doctor’s visits, other outpatient care, home health services and other medical services. Part B also covers preventative services, such as the flu. Part B requires that you pay a premium each month. Some people may have to pay more depending upon their income. A social security representative will contact you if this applies to your situation.
Part C – Medicare Advantage Plan. The Medicare Advantage Plan is more like an HMO or a PPO. These plans are offered by private companies, but are approved by Medicare. This plan will include your Hospital Insurance (Part A) and Medical Insurance (Part B). The Medicare Advantage Plans will also offer extra coverage, including vision, dental, hearing and other wellness programs.
There are numerous Medicare Advantage Plans, so the patient’s out-of-pocket expenses will vary based upon the private company’s charges. Deductibles, monthly premiums, copayments, annual fees and out-of-network fees will all factor into your total out-of-pocket expenses.
Part D – Prescription Drug Coverage. Medicare provides prescription drug coverage to everyone with Medicare. Medicare recipients can enroll in the prescription drug coverage any time between October 15th and December 7th.
If you do not enroll when you are eligible, you will probably pay a late enrollment fee. Most seniors enroll in private plans approved by Medicare. The plan costs will vary based upon the cost and drugs covered. There are four different plans available: Original Medicare, Medicare Cost Plans, Medicare Private Fee-for-Service (PFFS) and Medicare Medical Savings Account (MSA) Plans.