Open enrollment began Monday for Medicare in 2011, drawing expectations and trepidation from seniors and doctors. This year, while seniors can look forward to more coverage, doctors face a 25 percent pay cut unless Congress intervenes.
The annual open enrollment season, from Nov. 15 through Dec. 31, offers Medicare beneficiaries an opportunity to change from one Medicare Advantage health plan to another and add, drop or change their prescription drug coverage.
According to Donald Berwick, MD, the administrator of the Centers for Medicare and Medicaid Services, open enrollment allows people with Medicare to compare their health and drug plan options and choose the coverage that best meets their needs.
"Although this is an annual event, this year is an especially important time for people with Medicare to take advantage of the open enrollment period," Berwick wrote in a federal blog. "The Affordable Care Act provides new benefits to most people with Medicare in 2011."
According to CMS, under the Affordable Care Act, Medicare beneficiaries in 2011 can expect:
- a 50 percent discount on covered brand name drugs if they fall into the prescription drug doughnut hole;
- a free annual wellness visit; and
- no co-pays for recommended preventive services.
While seniors may be happy with more coverage, open enrollment comes as Medicare physicians threaten to drop from the program due to an impending 25 percent reimbursement cut beginning Dec. 1.
A poll conducted by the American Medical Association indicates 94 percent of Americans are concerned about the cut and want Congress to act.
According to AMA President Cecil B. Wilson, MD, "physicians want to care for seniors, but it is nearly impossible for many physicians to keep their practices open to all Medicare patients when they face such a cut." He said the AMA is calling on Congress to stop the cut for at least 13 months, allowing lawmakers to work out a permanent solution.
The AARP is advising Medicare beneficiaries who have changed their medications, been diagnosed with a new medical condition or moved to a new location to review their plan because it may no longer be the best option for them.
"Medicare plans also change. The costs of your plan can go up, or down, and prescription drugs can be added or dropped from the list of drugs (the 'formulary') included in your plan," the AARP advises. "Some Medicare plans stop offering coverage in a particular location."
The Medicare Rights Center, a national consumer service organization, advises that even people who are happy with their plan should review their options, because plans make changes.
"This year, as in past years, we urge Medicare consumers to carefully review all of their options," said Joe Baker, the center's president. "Low-cost options may appear attractive at first, but it is very important to read the fine print. "
"Similar plans from the same company have been consolidated for 2011, and the differences among the plans that consumers will have to choose from will be clearer this year," Baker said. "People whose plans have been consolidated will automatically be enrolled in a plan from the same company that has benefits most similar to the plan."