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Your Health
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David Sayen: Medicare Open Enrollment — It’s Different This Year

A review can ensure your health and prescription plans still meet your needs in terms of cost and coverage

Medicare’s open enrollment season begins earlier and lasts longer this year than in the past.

David Sayen
David Sayen

Open enrollment will start Oct. 15 and continue through Dec. 7. This is the time when people with Medicare should carefully review their Medicare health and prescription drug plans.

These plans can change from year to year. Premiums can go up and drugs can be dropped. So it’s important to make sure that your plan still meets your needs in terms of cost, coverage and convenience.

During open enrollment, you can join a plan or cancel one that no longer suits you.

A good way to shop for a new plan is to go to the www.Medicare.gov Web site. Click on “Compare drug and health plans.” Using the Medicare Plan Finder tool, you can plug in your ZIP code and see a list of plans that provide coverage in your area.

Plan Finder shows a plan’s monthly premium, deductible, whether you have to go only to doctors in the plan network, and your estimated annual health and drug costs.

The Formulary Finder tool on the Medicare Web site lets you enter the medications you’re taking and search for Medicare Part D plans that cover them.

Information on health and drug plans in your area also can be found in the “Medicare & You” handbook, which is mailed each fall to every Medicare beneficiary.

Or you may want to call our toll-free help line, 1.800.633.4227. Customer representatives are available 24 hours a day, seven days a week to help walk you through your health and drug plan options.

If you prefer face-to-face counseling, that’s available, too. Just call for an appointment with the closest office of your state Health Insurance Counseling and Advocacy Program, or HICAP.

In California, the HICAP number is 1.800.434.0222. The call and the counseling are free. The California HICAP is a terrific program. Many of the counselors are Medicare beneficiaries themselves, and they can help you with a wide variety of issues, including enrollment.

The good news for next year is that we expect average premiums for Medicare Advantage health plans to be 4 percent lower than this year. Average premiums for Medicare prescription drug plans are expected to be about the same next year.

Thanks to the Patient Protection and Affordable Care Act, people who enter the coverage gap, or doughnut hole, in their Part D drug plan will be able to get a 50 percent discount on brand-new drugs.

In addition, you’ll have access to preventive health services at no out-of-pocket cost. These services include cancer screenings and a new annual wellness visit with your doctor. During this visit, you and your doctor can discuss your health status and develop a personalized care plan.

We’ve also begun to rate Medicare Advantage plans based on our Five-Star Rating System. You’ll be able to see each plan’s star rating when you go on the Plan Finder. This year, for the first time, you’ll see a gold star icon designating the top rated five-star plans. You’ll also see warnings for plans that are consistently poor performers.

I encourage all Medicare beneficiaries enrolled in private plans to know their plan’s overall star rating and to consider enrolling in plans with high ratings. When comparing plans, you should consider the plan’s quality in addition to its costs, coverage and other conveniences. Part D plans also receive quality ratings.

So don’t forget: Medicare open enrollment begins Oct. 15 and ends Dec. 7. The earlier time frame will allow us to process any changes you make and ensure that you have your new membership card in hand on Jan. 1, 2012.

— David Sayen is the regional administrator for California, Arizona, Hawaii, Nevada and the Pacific Trust Territories for the U.S. Centers for Medicare & Medicaid Services. For answers to Medicare questions 24/7, call 800.633.4227.

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