November 11th, 2010
12:06 PM ET

What do we need to know about Medicare open enrollment?

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.

soundoff (27 Responses)
  1. Shirley Horn

    Would like to know if I buy a Medicare Supplement for the first time & I have something pre-exiting can they keep from selling me one & turn me down? Really need to know the law.

    November 11, 2010 at 22:00 | Report abuse | Reply
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    November 12, 2010 at 16:24 | Report abuse | Reply
  3. Michael T.

    Writing about Medicare drug plans, you state, "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." If I'm not mistaken, it's not when the member [senior] has spent more than $2,830, but when Medicare and the member have, together, spent more than $2,830. That's a lot sooner.

    November 13, 2010 at 10:05 | Report abuse | Reply
  4. Kirk Dickson

    What good is Medicare when you can't find a Dr. Also how can I find a supplement plan I can afford ?

    November 14, 2010 at 09:27 | Report abuse | Reply
  5. Kirk Dickson

    I thought I found a Dr. Saleemi. She supposed to be a pain specialist. She gave me pain blocker for back. Two days later my hips wouldn't let me walk w/o a cane, so she told me to find another Dr. I did not do anything wrong like failing drug test. I believe she just wanted my $155 deductible and cost for treatment. Are there other people that have expieanced this kind of thing ? If so what did you do about it and were you able to find a caring Dr. with medicre.
    Discuraged in Austin, TX. PS stay away from her !!

    November 14, 2010 at 09:47 | Report abuse | Reply
  6. Kirk Dickson

    Dr. Saleemi in Austin, TX non caring. STAY AWAY !!!!!!!!!

    November 14, 2010 at 09:52 | Report abuse | Reply
  7. Jeremy Engdahl-Johnson

    With reform in place, what are the primary Part D considerations for employers? http://www.healthcaretownhall.com/?p=3175

    November 14, 2010 at 14:39 | Report abuse | Reply
  8. paul caton

    if you get medicare a and do not get a supplement plan can or will they drop you??????????????

    February 3, 2011 at 22:46 | Report abuse | Reply
  9. Heather

    Finding a medicare supplement plan isn't that hard. First you need to find a broker who represents multiple companies. Since the Federal Government standardized the plans, each company's plan must offer the same benefits as every other plan. THerefore price and company strength become the deciding factor. More so price than company strength.

    The process is this, your doctor files a claim with Medicare (CMS); Medicare dictates what the insurance company will pay the provider. If the company does not pay what Medicare mandates; it's bad news for the insurance company. So, each company will pay claims the same way and will pay the same amount.

    There are other factors that you should weigh, but those involve your cashflow situation. Again, always work with a broker who will shop your plan and find you the best rate in your area. I hope this is helpful to you all.

    The confusion on this board is proof of why people need the services of a medigap consultant or broker.

    March 16, 2011 at 23:58 | Report abuse | Reply
  10. toddoldfield602

    Doc; it's October 15th-December 7th. LOL. Not November.

    It begins today!


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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.