Things to watch for as Medicare open enrollment gets underway

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Photo: jennie-o via Flickr

Photo: jennie-o via Flickr

This week marks the start of Medicare’s open enrollment period, when beneficiaries can shop for a Medicare Advantage (MA) or Prescription Drug Plan (PDP) for 2016. Open enrollment happens every year from Oct. 15 through Dec. 7.

The Centers for Medicare & Medicaid Services is encouraging people with Medicare to check whether they’re getting the best price and quality plan available based on their current and anticipated health needs. “Even if you are happy with your current coverage, take the time to investigate all of your options and determine if a better option is available,” Andy Slavitt, CMS acting administrator, said in a statement. “You might be surprised to find a higher-quality, lower-cost plan in your area.”

For 2016, Medicare beneficiaries will have access to even more plans with high-star quality ratings at stable or lower costs, Slavitt said. The average basic Medicare PDP premium in 2016 will remain stable at $32.50 per month, the agency estimates, while the average MA premium will decrease to $32.91. Approximately 49 percent of 2016 MA plans and 41 percent of PDPs earned 4 stars or higher in their 2016 overall rating.

Though CMS remains optimistic about price increases, a closer look reveals that seniors may end up paying more for some plans and prescriptions. The Pittsburgh Post-Gazette reported that premiums for seniors may actually increase by $650 in 2016. An in-depth analysis from the Kaiser Family Foundation concluded that “the national average monthly PDP premium is expected to increase for 2016.”

CMS said that since 2010, closing the prescription drug “doughnut hole” has saved nearly 10 million Medicare beneficiaries more than $17.6 billion on prescription drugs through July 2015. Since the law passed, MA premiums have fallen by an estimated 10 percent while enrollment has climbed by over 50 percent.

“Costs for Medicare Advantage and prescription drug plans can vary by location,” Slavitt said. “That’s why it’s important for people with Medicare to review their plan, shop and compare all their options.”

Beneficiaries can visit Medicare.gov to search for plans that fit their budget. They can compare costs, premiums and star ratings for 2016 MA health and drug plans. Plans with 5-star ratings are eligible to enroll beneficiaries at any time during the year.

Beneficiaries who are satisfied with their current coverage and feel it will meet their needs for 2016 do not need to do anything. Those with original Medicare are eligible to shop for a health or drug plan, and individuals with a MA health plan may use open enrollment to switch to original Medicare.

People with Medicare, their families and caregivers can review and compare current coverage with new plan offerings, using resources such as:

  • medicare.gov, which has information on plan coverage, costs and instructions on how to enroll in a new plan if a beneficiary decides to make a change.
  • 1-800-MEDICARE (1-800-633-4227) provides around-the-clock assistance on coverage options.
  • One-on-one counseling is available from the State Health Insurance Assistance Programs (SHIP).
  • Medicare enrollees with limited income and resources may qualify for the Extra Help program to cover prescription drug costs.
  • Additional information from CMS on premiums and costs for 2016 health and drug plans.

Journalists may want to review these articles for ideas and resources:

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