Resources for Researching Medicare Plans During Open Enrollment

Open Enrollment for Medicare Began This Week, Will Continue Through Dec. 31^st

Earlier this week, the Open Enrollment period for Medicare began. This is an important time when all Medicare recipients can review their current health and prescription drug coverage plans (be it Original Medicare, a Medicare Advantage Plan, a stand-alone prescription plan or some combination thereof), compare other coverage plans available in their area and choose a plan that’s right for them.

This year, seniors should keep in mind the new benefits they can expect to be taking effect on Jan. 1^st, 2011 thanks to the Patient Protection and Affordable Care Act. They include:

• A 50% discount on covered brand name drugs (and 7% on generics) if folks hit that ‘donut hole’ gap in prescription drug coverage
• A free annual wellness visit and flu shot
• No co-pays for recommended preventive services like: annual mammograms for those age 40 and older, cervical cancer screening, including a Pap test and pelvic exam, prostate cancer screening colorectal cancer screenings, diabetes screening, cholesterol and other cardiovascular screenings and medical nutrition therapy to help manage diabetes or kidney disease.

The Patient Protection and Affordable Care Act also makes investments to strengthen and improve Medicare for years to come, including:

• Extending the life of the Medicare Trust fund by at least 12 years until 2029 by reducing waste, fraud and abuse, and bending the cost curve in Medicare (which will also bring future savings for seniors on premiums and coinsurance); folks can learn more about the efforts to stop Medicare fraud here: http://www.stopmedicarefraud.gov/.
• Closing the donut hole entirely by 2020, with those steep discounts (50% for brand name drugs) continuing until then.
• Improving the coordination of care between your doctors in order to reduce harmful things like hospital acquired infections and unnecessary and preventable re-admissions to the hospital for the same condition.
• Ensuring that Medicare Advantage Plan members are protected and getting the most bang for their buck by requiring insurers to put at least 80% of your premium dollar toward actual health care (not profits, CEO salaries, advertising and other overhead that do nothing to improve the quality of your benefits or lower the cost of your premiums).

Medicare Advantage plans change from year to year, so it’s important to look for plans during this period that may result in greater savings or better coverage. There are a lot of great resources and comparison tools on Medicare’s official website and through their national, toll-free hotline, 1-800-MEDICARE. 

In Pennsylvania, seniors can receive free one-on-one counseling from our State Health Insurance Assistance Program (SHIP) called APPRISE.

APPRISE is a federally funded service that provides free, objective health care education and counseling for Medicare beneficiaries. Most APPRISE programs across the state work in close partnership with local Area Agencies on Aging and most will be scheduling community events and seminars to help seniors and their families investigate their coverage options.  

Here’s a few of the services offered by APPRISE. They can help you to:

• Understand your Medicare benefits by explaining what services are covered under Original Medicare (Parts A and B) and any additional health coverage you have
• Choose a health insurance plan that fits your needs and your budget
• Navigate the Medicare appeals process 
• Learn about Medigap policies and Medicare Advantage plans that supplement Original Medicare coverage
• Find out if you qualify for financial assistance programs that may help pay for your Medicare premiums, annual deductibles and prescription co-pays, and apply for those benefits 
• Understand the Medicare prescription (Part D) benefit

For more information, to schedule an appointment or to talk with an APPRISE counselor in your area, call 1-800-783-7067 between 9am and 4pm or visit http://www.aging.state.pa.us.

Also, please check out the Pennsylvania Health Law Project’s October 2010 edition of Senior Health News for more valuable information on PACE and PACENET in Pennsylvania, and the new disenrollment period that begins in January where folks can drop their Medicare Advantage plans and return to Original Medicare if they aren’t satisfied with their coverage.

And if you’re part of a senior group or church where you’d like to have us come and talk more about health reform and its impact on seniors and Medicare, please get in touch with us to set that up:

In the west, contact: Erin Gill, egill@pahealthaccess.org or 412-512-9225

In central PA, contact: Alison Hirsch, ahirsch2008@gmail.com or 570-974-3101

In the east, contact: Athena Ford, aford@pahealthaccess.org or 267-257-6968

PHLP Senior Health News Oct. 2010.pdf

AARP HCR and Medicare.pdf