What changes will there be to open enrollment for Medicare
Part D and Medicare Advantage plans this year? When do I need to
decide on my 2013 plan?
After some big Medicare changes last year, such as
expanding preventive-care benefits
and
bumping up the time frame
for Medicare open enrollment, this year's changes are much smaller.
The doughnut hole (the period during which you must pay out of
pocket) for Part D prescription-drug coverage continues to close:
The discount on brand-name drugs in the coverage gap will rise from
50% to 52.5%, and the federal subsidy to help pay for generics will
rise from 14% to 21% in 2013. And people can now
switch Medicare Advantage plans outside of open
enrollment
if they're in an area that has a plan with a five-star quality
rating (only 12 plans qualified in 2012, but more are expected to
make the cut in 2013).
The Centers for Medicare and Medicaid Services estimates that
the average premiums for Part D plans will continue to be about $30
per month, essentially the same as last year's average cost. But,
as we've seen in the past, plans can make other changes - -such as
boosting co-payments or changing pricing tiers for your medications
-- that don't show up in those averages but that result in higher
out-of-pocket costs. Medicare Advantage plans, which cover drugs
and medical expenses, can also change coverage and prices. Jan
Berger, chief medical officer for Silverlink Communications, which
helps Medicare Advantage plans with consumer outreach programs,
also expects some Medicare Advantage plans to narrow their networks
-- that is, you can't assume that your doctors will remain in the
plan's network in 2013.
You should receive the plan's Annual Notice of Change in
September, which will let you know if your Part D or Medicare
Advantage plan will be changing premiums or coverage in 2013, or if
it will be leaving the business. This document also includes the
plan's quality star ratings, which show how your plan stacks up
based on 50 measures of coverage, communications and customer
service.
Insurers can start marketing their 2013 plans by October 1
(which is when the
Medicare Plan Finder
is updated with the 2013 plan information). You then have from
October 15 to December 7 to pick your Part D or Medicare Advantage
plan for next year. If you don't do anything, you'll automatically
be re-enrolled in the same plan (unless it is leaving the
business). But even if you've been happy with your plan, this is a
great opportunity to review your options and see if another plan
offers a better deal, especially if your plan boosts premiums and
co-payments, or moves your medications to a more-expensive pricing
tier, or if you've been prescribed new medications since you last
searched for plans. Also see how your plan's quality rankings
compare with the others in your area. For more information about
tools and resources to help you compare Part D or Medicare
Advantage plans, see
How to Evaluate Your Medicare Options
.
It's also a good time to reassess whether you want to get
coverage through traditional Medicare plus a medigap policy and
Part D prescription-drug coverage, or if you'd like to get both
your medical and drug coverage through Medicare Advantage. (You can
switch Part D plans during open-enrollment season, but medigap
policies don't have the same open-enrollment schedule.) If you
switch medigap plans more than six months after you originally sign
up for Medicare Part B, you could be charged a higher rate or
denied coverage for a new medigap policy based on your health,
whereas you can switch Medicare Advantage plans, or move from
Medicare to a Medicare Advantage plan, during open-enrollment
period regardless of your health.