How health care reform affects your Medicare enrollment

(ARA) – Health care legislation passed earlier this year may make Medicare annual enrollment season particularly challenging for the millions of baby boomers aging into Medicare and for seniors already enrolled who are considering different coverage for 2011. Annual enrollment runs from Nov. 15 to Dec. 31, allowing people to select their Medicare coverage for 2011.

“Choosing a Medicare plan can be overwhelming in any year,” says Adrienne Muralidharan, senior Medicare specialist for the Allsup Medicare Advisor, a Medicare plan selection service for people with disabilities and those 65 and older. “However, this year there are not only the usual changes, such as premium and coverage changes, you also need to understand how the Patient Protection and Affordable Care Act may affect your 2011 Medicare coverage.”

According to Muralidharan, the most important ways the new health care legislation will affect Medicare beneficiaries for 2011 include:

* Prescription drug costs should be lower in the “doughnut hole.” For 2011, Medicare beneficiaries will receive a 50 percent discount for the cost of brand-name prescription drugs and a 7 percent discount for generic drugs they are taking while in the prescription drug doughnut hole.

* Medicare Part B (medical insurance) will fully cover preventive care. Beginning in 2011, Medicare beneficiaries will no longer have to pay deductibles or co-pays for preventive services that fall under U.S. Preventive Service Task Force guidelines, such as an annual wellness exam.

* More beneficiaries may have higher costs for Medicare Part B and Part D (prescription drug) coverage. The Part B income threshold freezes at the 2010 levels through 2019. As a result, individuals with modified adjusted gross income (income) exceeding $85,000 and married couples with income exceeding $170,000 will have to pay higher premiums. Because this will not adjust with inflation, it’s likely more people over time will be subject to higher premiums. In addition, the law reduces the Medicare Part D premium subsidy for individuals with incomes above these levels.

* Opportunities to change coverage after the annual enrollment period will be more limited. Historically, an open enrollment period ran from Jan. 1 through March 31, immediately after annual enrollment ended. During open enrollment, people were able to switch from their existing Medicare plans to similar Medicare coverage, choosing from “like to like” options.

Now, open enrollment has been replaced with a shorter annual disenrollment period, which runs from Jan. 1 through Feb. 14. During this period, the only change that can be made is to disenroll from a Medicare Advantage plan in order to enroll in traditional Medicare and join a Medicare Part D plan. Other selections will not be available to consumers.

“It’s easy to get confused over the various Medicare enrollment periods,” Muralidharan says. “However, it’s now more important than ever to look at annual enrollment as your main opportunity to choose your coverage.”

Reasons to review your medicare coverage

Changes brought on by health care reform are just one reason people should evaluate their Medicare coverage. Each year, individuals with Medicare should consider different health care coverage if they experience any of the following:

* Your health situation has changed in the past year.

* Your provider situation has changed (for example, you hospital or physician left your plan).

* Your coverage has changed (for example, certain drugs, procedures or conditions are no longer covered).

* Your plan premiums and/or co-payments have increased.

* You have moved to a new location.

* Your current plan no longer will be available.

Additionally, people now turning 65 and becoming Medicare-eligible for the first time should carefully review their options – and make certain they follow the enrollment guidelines. Failing to do so can trigger costly penalties and may mean certain coverage is unavailable in the future.

“The choices you make about your Medicare coverage can have a significant effect on your health care and your finances,” says Muralidharan. “If you are uncertain about which Medicare plans are available to you, or which would best meet your needs, seek help before enrolling.” More information on Medicare plan selection assistance is available at Medicare.Allsup.com or (888) 271-1173.

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