The Life Transition Blog

Open enrollment season is almost here, a bit earlier than usual! This year, Medicare beneficiaries can enroll or change their selection for Medicare Advantage and Part D prescription drug plans between October 15 and December 7. This is a full month earlier than in past years. Don’t wait until the last minute to evaluate your options or remind your clients to do so. Every Medicare enrollee should review their options each year. This is because your medical status might have changed, or because the medications you take may be different from last year. Finally, even if everything on your side has stayed exactly the same, the terms and conditions of your plan might have shifted and this could mean that you will have unexpected expenses if you don’t make a modification.

In addition to the new open enrollment timing, there are a few other changes to Medicare for the coming year. The hated “doughnut hole” or “coverage gap” in Part D Rx plans is shrinking, and that’s good news, brought to you as a result of the health care reform legislation passed in 2010.

The shrinkage comes from three places. First, the amount of money beneficiaries must spend on prescriptions before entering the coverage gap goes up by $100 for 2012. Next, the spending inside the gap is shrinking by nearly $1,750 meaning you have to spend less out of pocket before reaching the catastrophic coverage. Finally, participants will receive a 50% discount on brand name drugs while inside the gap and pay 86% of the cost of generics (vs. 93% in 2011).

Additional changes include an annual wellness visit with no patient responsibility portion, a new “special enrollment period” where participants can switch to a “5 star rated plan” at any time during the year, and the Blue Button which will provide online access to Medicare claims and allow beneficiaries to store personal health information if they choose.

While the noted changes are positive, Medicare continues to be confusing and overwhelming to many older adults. They still must decide whether to subscribe to “original” Medicare (Part A and Part B) or to choose Part C, or Medicare Advantage plans. Assuming the choice is original Medicare, further decisions include whether to purchase a Medigap (a/k/a Medicare Supplement) plan or a Part D prescription drug plan. If either of those is desired, then there is a further decision regarding which plan to purchase and through which insurance company.

Medicare beneficiaries can get personalized help to sort this all out by taking advantage of LifeBridge Solution’s “medical plan selection service”. For $129 (or $199 for a couple), we will sit with you or your client one-on-one and determine the options available for your particular situation. Since we don’t sell insurance we are unbiased and able to educate and advise you without regard to external incentives. Be sure to schedule early! Remember, open enrollment season ends on December 7!