Are You Ready to Help Patients Assess Medicare Options?

Open enrollment for Medicare begins November 15, and patients may be requesting clinicians' advice in making choices.

Each year Medicare Advantage plans (the program in which beneficiaries receive coverage through Medicare-approved managed care companies) change what they charge and what they cover. Individuals can select a new health plan for their 2011 coverage and can add, drop, or change their prescription drug coverage. Enrollees in original Medicare can also choose to switch to Medicare Advantage.

Open enrollment ends December 31.

Enrollees in Medicare health plans or the Part D prescription drug program who are satisfied with their coverage do not need to do anything.

Approximately 5 percent of beneficiaries enrolled in Medicare Advantage and prescription drug plans must choose a new health plan or else choose original Medicare because their current plan is not renewing its contract with Medicare in 2011.

Most of these “nonrenewals” occur because private fee-for-service plans made business decisions to leave Medicare in certain areas of the country. Beneficiaries should be notified of nonrenewal before the end of this month.

Enrollees in nonrenewing health plans who do not enroll in another health plan will receive medical coverage under original Medicare. However, individuals in Part D prescription drug plans that do not renew must reenroll in another Part D plan to continue to receive drug coverage, according to the Centers for Medicare and Medicaid Services (CMS).

(An exception is made for beneficiaries eligible for the Part D low-income subsidy; they will automatically be enrolled in a zero-premium drug plan if they do not select a plan.)

CMS is encouraging beneficiaries enrolled in Medicare Advantage and Medicare prescription drug plans to review their current health and drug plan coverage for any changes their plans may be making for 2011 before the annual enrollment period begins.

In a statement released at the end of September, CMS said the majority of Medicare beneficiaries enrolled in Medicare health and prescription drug plans this year should find little or no change in benefits in 2011 but will see more drug plans offering coverage in the prescription drug coverage gap.

CMS also said that premiums for individuals enrolled in Medicare Advantage plans will be 1 percent lower on average in 2011 than this year, while enrollment in Medicare Advantage is expected to increase by 5 percent.

“Despite the claims of some, Medicare Advantage remains strong and a robust option for millions of seniors who choose to enroll or stay in a participating plan today and in the future,” said CMS Administrator Donald Berwick, M.D., in a statement.

CMS noted that the new health care reform law provides some new benefits to Medicare beneficiaries in 2011, including free wellness visits, some new free health screenings, and a 50 percent discount on brand-name drugs for seniors who fall into the coverage gap.

More information on Medicare plans and open enrollment is posted at <www.cms.gov/center/openenrollment.asp>. The Medicare Plan Finder is posted at <www.medicare.gov/find-a-plan/questions/home.aspx>.