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Medicare Enrollment Comes Earlier This Year

Oct 24, 2011
Originally published on October 24, 2011 6:03 pm

If you're a senior on Medicare — or an adult child responsible for a senior on Medicare — here's something you should know: The annual "open enrollment" period for joining or changing prescription drug or private health plans is already under way.

"It's much earlier this year. It started on Oct. 15, and it's going to stop on Dec. 7," says Nancy Metcalf, a senior editor and health expert at Consumer Reports. "So you have your window right now."

Metcalf says the dates were moved up in part so plans could get all their paperwork done — and put new membership cards in patients' hands — by Jan. 1, when plan changes take effect.

But the new dates are only one of several changes Metcalf says Medicare enrollees need to be aware of for next year. Consumer Reports has a free guide to some of them.

A key change she says consumers should be aware of during the open season is a new "star-based" quality rating, particularly for health plans.

"You want 4 to 5 stars," Metcalf says. And the reason that matters is that "those plans are getting more money from Medicare. They're basically getting bonuses for being good."

And more money, in this case, means more benefits, she says, because "one of the deals is the extra money has to go toward benefits to the members, not into the pockets of the plans."

But no matter how many stars a plan has, last year's health law is guaranteeing certain new benefits to everyone enrolled in the private Medicare plans known as Medicare Advantage.

In 2011, everyone in traditional Medicare was guaranteed a series of free preventive benefits, including an annual wellness exam and screenings for things like cancer and heart disease. Starting in 2012, those benefits will have to be offered by Medicare Advantage plans, as well.

Next year will also see a further constriction of the notorious "doughnut hole" gap in Medicare prescription drug coverage, where people continue to pay premiums but essentially get no benefits. In 2012, people who reach the gap will automatically get a 50 percent discount on their brand-name prescription drugs, and a 14 percent discount on generic medications.

Metcalf says even if you spend a lot on drugs and will hit that gap, the Medicare plan finder website can help you budget. If you enter both the drugs you take and the drugstores you plan to use, she says, "you get this amazing spreadsheet that will tell you month by month how much out of pocket you're going to pay, and then exactly when you're going to hit the doughnut hole."

By 2020 the gap is scheduled to phase out altogether.

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This is MORNING EDITION, from NPR News. I'm Renee Montagne.

ARI SHAPIRO, HOST:

And I'm Ari Shapiro.

Today in Your Health, a bit of good news. Some of the most expensive brand-name drugs are about to get cheaper. But first, seniors are making decisions about their Medicare plans a little earlier this year. NPR's Julie Rovner tells us what's new this year in prescription drug and other private coverage.

JULIE ROVNER, BYLINE: Open season is the one time each year when seniors and other Medicare patients can change their health or drug plans without penalty. And if it seems a little earlier this year than usual, well, it is.

NANCY METCALF: It started on October 15th and it's going to stop on December 7th.

ROVNER: Nancy Metcalf is a senior editor with Consumer Reports. Open enrollment used to run from mid-November to the end of the year.

METCALF: It's going to be too late if you wait till Christmas.

ROVNER: So if you're a senior or, like me, an adult child in charge of a parent's annual Medicare open enrollment exercise, the changed calendar means it's time to get your act in gear.

I need your Medicare card.

SANDY ROVNER: Yes, I will get it for you.

ROVNER: Back when Medicare's prescription drug program was just being launched, I chronicled the story of one particular senior's quest to sign up for a plan.

S. ROVNER: I'm Sandy Rovner, and I'm Julie Rovner's mom.

ROVNER: Mom was actually pretty healthy back in 2005.

S. ROVNER: Although I don't pay that much for drugs now, I don't have that many drugs that are expensive or new, who knows what will happen tomorrow?

ROVNER: Well, it's six years later, and Mom is - how old are you, Mom?

S. ROVNER: I'm 83.

ROVNER: And she's still in pretty good health. But she takes a lot more prescription drugs. And until last year, we changed her prescription drug plan every year to get a better price. So when we sat down at her computer one evening last week and signed on to Medicare's website, it felt like a pretty familiar drill.

(SOUNDBITE OF TYPING)

ROVNER: Effective date for part A, September '93.

Once we're signed in, the website takes us straight to Mom's list of medications, which it saved from last year. That's a nice thing. The bad news is that updating the list every year can still be a bit of a chore.

The pravastatin, are you still taking 40 mg?

S. ROVNER: No, 80.

ROVNER: OK, so we need to change the dose.

Eventually, the website takes us to a list of drug plans in Mom's area - 31 plans, in our case.

As it turns out, there's only one plan that's cheaper than Mom's current plan, and it's only slightly less expensive. Nationwide, prices for Medicare drug plans have remained relatively stable for next year.

And, a bit unexpectedly, prices have also remained stable for the private HMOs and PPOs known as Medicare Advantage plans. Premiums were expected to rise, because the federal government is cutting back some of its payments to those health plans. But so far, Nancy Metcalf of Consumer Report says consumers aren't seeing much impact.

METCALF: In fact, Medicare Advantage premiums are going down slightly for 2012, and there is still a robust choice of plans for the vast, vast majority of Americans.

ROVNER: Metcalf says if you want to join or change your Medicare Advantage plan this open season, there is something you should look for: a new star rating for quality. In particular, look for plans with four or five stars.

METCALF: The reason that matters is that those plans are getting more money from Medicare. They're basically getting bonuses for being good.

ROVNER: And more money means more benefits, things like vision or hearing coverage. There's also more benefits thanks to last year's health law. Next year, everyone in Medicare is eligible for a free wellness visit with their doctor and free preventive screenings for things like cancer and hypertension. And for those with prescription drug plans, that gap in coverage known as the donut hole will continue to get smaller.

Julie Rovner, NPR News. Transcript provided by NPR, Copyright NPR.