THURSDAY, Nov. 11 (HealthDay News) -- Seniors enrolled in
Medicare Part D prescription drug plans will come across some
changes as they choose a new plan or reassess an old one during the
upcoming open enrollment period, but experts say those differences
won't be monstrous.
Open enrollment starts Nov. 15 and continues through Dec. 31,
and any changes will take effect Jan. 1, 2011.
"Some of the doom-and-gloom predictions because of health-care reform or the freezing of Advantage Program payments [Medicare benefits provided through private plans] have been a major distortion that haven't come to pass," said Joe Baker, president of the Medicare Rights Center, a nonprofit consumer counseling and advocacy group. "While there are changes and new things to look at, it's not a lot of change."
Medicare Part D prescription coverage comes in two forms:
original prescription drug plans (PDPs), which simply add drug
coverage to Original Medicare, and Medicare Advantage Plans, which
are like HMOs or PPOs.
Next year, 1,109 PDPs will be offered nationwide, the fewest
since Part D was introduced in 2006. The average Medicare
beneficiary will have a choice of 33 PDPs, although this number
will vary from state to state.
"Seniors will continue to have many Part D plans, even though the overall number has declined," said Tricia Neuman, vice president and director of the Medicare Policy Project of the Kaiser Family Foundation.
The average monthly premium will rise 10 percent in 2011, to an
average of $40.72. These can range from a low of $29.01 (in New
Mexico) to a high of $46.51 (in Utah/Idaho), according to the
Kaiser Family Foundation. In 2011, Medicare beneficiaries receiving
low-income subsidies will have access to a larger number of plans
that have no monthly premiums, according to the Kaiser
But good news comes in the form of 2011 "donut hole" coverage,
the gap that sets in after regular coverage has been reached and
before catastrophic coverage kicks in. The consumer's share of
costs will continue to decrease, until the doughnut hole is closed
completely in 2020, according to the Medicare Rights Center.
Beneficiaries who find themselves in the donut hole will see a
discount of 50 percent for brand-name drugs and 7 percent for
That 50 percent coverage will be "a real help with relatively
high drug costs," said Neuman.
The gap will start after $2,840 has been spent on drugs, while
catastrophic coverage takes over at $4,550 out-of-pocket spending,
according to Kaiser.
To choose the best plan for them, beneficiaries will have to do
some digging during the upcoming enrollment period.
"Year in and year out, you have to look at things again because plans, drugs and your health changes. You need to make sure your plan is still a good deal," said Baker.
Look at premiums but also look beyond that, at factors like
which drugs are covered by a specific plan, how much those drugs
will cost you and if there's a limit on the number of
"Cheaper isn't necessarily better if a drug isn't approved for the plan. Then the cheap plans isn't so cheap any more," Baker explained.
"There are still many choices, but it's a good idea to compare and reassess if it's the best plan," Neuman added.
Although the open enrollment period is the same as last year,
seniors should note that the Jan. 1 to Feb. 14 disenrollment period
for Medicare Advantage plans is different.
"In the old days, you could either disenroll and move to Original Medicare or move to another Advantage plan,." Baker said. "This year, you can only move to Original Medicare."
U.S. Centers for Medicare & Medicaid
Services has more on the prescription drug plans.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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