November 11th, 2010
12:06 PM ET
As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.
From Mary, Walnut Creek, California
"What should my husband and I know about open enrollment for Medicare?"
Mary, thank you for your question. As you know, open enrollment begins November 15 for Medicare, the government program that currently provides health insurance to more than 38 million Americans, mainly adults ages 65 and older. With the passing of the health care reform legislation, Medicare officials say there are more benefits and protections available to current and new enrollees. Here are the top six highlights.
1. No copays for preventive care services
According to the Centers for Medicare & Medicaid Services, people with Original Medicare will not have to pay copays, coinsurance or deductibles for those preventives services with a Grade A or B recommendation from the U.S. Preventive Services Task force. Medicare Advantage plan recipients will not receive this benefit.
2. People in higher income brackets will pay higher premiums
According to the Department of Health and Human services, about five percent of current Part B enrollees are may be subject to higher premium amounts based on annual income. Individuals making more than $85,000 a year and couples with joint incomes of than $170,000 a year are responsible for a larger portion of the costs.
DHS says monthly premiums help cover everything from physicians’ services to equipment. Check out page 3 of the DHS Medicare Factsheet for 2011 for a detailed breakdown of how your annual income will impact what you pay.
3. Discounts on prescriptions starting in 2011
“Starting in 2011 people who enter the coverage gap will receive a 50 percent discount on brand name drugs and a 7 percent discount on generic drugs," explains Joe Baker, president of the Medicare Rights Center.
Medicare officials say this discount should increase annually, until the "doughnut hole" closes in 2020. The "doughnut hole", refers to the gap in Part-D where Medicare stops paying once a senior has spent more than $2,830 on prescription drugs and resumes when the individual's out-of-pocket spending has reached about $4,550.
Check out the Medicare Plan Finder to help narrow your search for a prescription drug plan based on costs, specific medications and pharmacy preferences.
In general, Medicare recipients will see average monthly premium charges for standard coverage drug plans go up by as much as 4.4 percent next year, with the standard Medicare Part B monthly premium increasing by $4.90 to a total of $115.40.
4. $250 prescription drug rebate for current enrollees
According to the CMS, if you currently have Medicare prescription drug coverage and do not receive assistance through Medicare Extra Help, you will automatically receive a tax free, one-time $250 rebate check once you enter the doughnut hole in 2010.
Medicare officials stress that the $250 rebate will come to you automatically; you do not need to apply, fill out an application or provide personal information to anyone over the telephone or on the web. They estimate more than 1.2 million beneficiaries have received their rebate checks so far, and millions more are expected to receive them by the end of the year. For more information on the rebate visit www.medicare.gov.
5. 'Medicare Advantage Disenrollment Period' starts in 2011
Medicare open enrollment runs from November 15 to December 31, 2010. During this time, beneficiaries can make whatever choices they like among the various Medicare programs, including the selection of a prescription drug plan.
Here’s what’s different.
Starting in 2011, a Medicare Advantage Disenrollment Period will be available from January 1 through February 14. The MADP is intended to help people who opted for a Medicare Advantage plan, but decided the plan does not meet their needs.
“In the past, Medicare Advantage participants could change insurers or go back to regular Medicare. Under the new law, a beneficiary will be allowed to only go from Medicare Advantage plans back to regular Medicare,” explains Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services. You will not be allowed to switch from original Medicare to Medicare Advantage during this time. The website Medicare.gov offers an overview of the differences between original and advantage plans.
Experts from the Medicare Rights Center say one thing to keep in mind when deciding which type of plan to choose, is that Medicare Advantage often comes with a prescription option, whereas many people on the original plan also need to purchase a supplemental health insurance policy called a Medigap. Check with your state’s health insurance assistance program about Medigap options in your area.
6. Better fraud protection
The Affordable Care Act provided for a new Health Care Fraud and Abuse Control Account, which Medicare officials have been using to staff teams for investigating and preventing Medicare fraud. According to the Department of Justice, False Claims accounted for more than 2.5 billion in settlements and judgments this year.
Officials warn people on Medicare to be wary if you receive calls asking you for banking information or verification of your personal Medicare number. There are also updated resources to help Medicare enrollees including a place to file a fraud victim report online with HHS, a website to help contact a local Senior Medicare Patrol officer, and information on Medicare fraud alerts in your state.
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.