Medicare’s Open Enrollment Season Already Underway

This year’s holiday shopping season has begun early for Medicare beneficiaries: the program’s Open Enrollment Period, during which you can enroll in or switch plans, began October 15 and ends on December 7.

During this period, you may enroll in a Medicare Part D (prescription drug) plan or, if you currently have a plan, you may change plans. In addition, during the seven-week period you can return to traditional Medicare (Parts A and B) from a Medicare Advantage (Part C, managed care) plan, enroll in a Medicare Advantage plan, or change Advantage plans. Beneficiaries can go to or call 1-800-MEDICARE (1-800-633-4227) to make changes in their Medicare prescription drug and health plan coverage.

Even beneficiaries who were satisfied with their plan in 2011 need to review their options for 2012, particularly because things are still in flux due to changes brought on by the health care law. Prescription drug plans can change their premiums, deductibles, the list of drugs they cover, and their plan rules for covered drugs, exceptions and appeals. Medicare Advantage plans can change their benefit package and as well as their provider network.

According to the federal Centers for Medicare and Medicaid Services (CMS), Medicare Advantage premiums are expected todecrease by an average of 4 percent next year from this year, while Part D plan premiums will likely increase about 2 percent to $30 a month, on average.

“There’s no doubt that a lot of seniors are in the wrong plan,” Ross Blair, the CEO of, a site that compares Medicare plans, told SmartMoney.  “A lot of them could save hundreds of dollars a year by switching.”

Reaching for the Stars

One change beneficiaries using the Medicare Plan Finder will notice this year is CMS’s enhanced five-star rating system.  Plans that have achieved a five-star rating from CMS are identified with a “gold star” icon.  Those that have received a low overall quality rating for the past three years are identified with a “warning signal” icon.  Another new innovation is that there is no time limit to switch into a five-star Advantage or prescription drug plan. Medicare beneficiaries have one opportunity to switch to one of these top-rated plans anytime during 2012. (For more on the significance of the star rating system, see“Medicare Plans See Dollars in the Stars.”)

If you want out of your Advantage plan after December 7, you can “disenroll” between January 1 and February 14.  At that point you can return to traditional Medicare and add a Part D plan, or move into a five-star Advantage plan.  But if you return to traditional Medicare you may not be able to buy Medigap coverage at that point, although the rules vary by state.

If you take no action, you will remain in your current plan unless your Medicare Advantage or drug plan is terminating its Medicare contract. Also, if you receive the Low-Income Subsidy (LIS) to help pay for some or most of your Part D drug costs, you may be randomly reassigned to a different plan. (For more on the LIS program, also known as “Extra Help,” click here.)

Some factors to consider when evaluating your drug plan include:

  • What is the monthly premium?
  • Does the plan continue to cover necessary drugs?
  • Does the plan provide coverage for drugs in the “doughnut hole” or coverage gap?
  • What pharmacies are covered under the plan?

Some factors to consider when comparing Medicare Advantage plans include:

  • What is the monthly premium?
  • What is the cost-sharing for doctor visits?
  • Which doctors and hospitals are covered?
  • Is prescription drug coverage included?
  • Are any other extra benefits included and will they be useful to you?
(For a MarketWatch article on picking an Advantage plan, click here.)

Remember that fraud perpetrators will inevitably use the Open Enrollment Period to try to gain access to individuals’ personal financial information.  Medicare beneficiaries should never give their personal information out to anyone making unsolicited phone calls selling Medicare-related products or services or showing up on their doorstep uninvited.  If you think you’ve been a victim of fraud or identity theft, contact Medicare.  For more information on Medicare fraud, click here or here.

Here are more resources for navigating the Open Enrollment Period:

For more about Medicare, click here.

To discuss Medicare or elder law issues with an attorney, please email the Elder Law Center or call 630-844-0065. The Elder Law Center is located in Aurora, IL, Kane County, in the Chicago Western Suburbs.

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