November 11th, 2011 at 11:49 am
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Medicare open enrollment: review your elder’s plan today

by Carol Bursack

In March, President Obama signed the Affordable Care Act into law. Designed to improve the health care system, the Affordable Care Act is designed to increase access to health coverage and provide new protections for individuals who currently have health insurance. Under the provisions of the Affordable Care Act, the Medicare open enrollment period this year is taking place between October 15 and December 7.

With the enrollment window quickly closing, now is the time to review your loved one’s current plan to see if any changes or updates are required.

Medicare open enrollment period

The open enrollment period is the one time that all individuals using Medicare make changes and update their prescription and health plans for the next year. According to, here is the timeline for Medicare enrollment:

  • October 15, 2011 – open enrollment began
  • December 7, 2011  – open enrollment ends
  • January 1, 2012 – coverage begins

Like any insurance plan, Medicare plans can change from year to year. In turn, it is worthwhile to review coverage options with your elder.

Medicare Part D outlook

Most Medicare prescription drug plans include a coverage gap (“donut hole”) that occurs when the senior and Medicare have reached a certain spending amount and the insured must pay all out-of-pocket costs for prescriptions up to a yearly limit.

  • Initial coverage limit. The initial coverage limit will increase to $2,930 in 2012
  • Coverage gap. The donut hole ends when the insured has spent $4,700 in 2012

The Affordable Care Act includes new provisions to assist seniors in the coverage gap or “donut hole.” This includes a 50% discount on the cost of covered brand-name drugs while the insured is in the donut hole. A maximum 86% co-pay on generic drugs applys during the coverage gap as well.

In addition, the Affordable Care Act works to close the coverage gap by reducing the amount of cost sharing incurred by the enrollee each year until the gap is closed.

Medicare Part B outlook

In 2011, the standard Part B coverage premium was $115.40. In 2012, that premium will drop to $99.90. However, since 2008, most Medicare recipients have incurred a monthly fee of $96.40 for their Part B coverage. For those experiencing a fee increase, there will be an offset for those with disabilities and all seniors through a Social Security cost of living adjustment. This cost of living adjustment should easily cover the premium increase for Part B coverage.

Part B provides coverage for medically-necessary services such as outpatient hospital visits and visits to the doctor’s office. Under the Affordable Care Act, a number of preventative screening services are no available at no charge for eligible recipients. Examples of these preventative services include annual physicals, immunizations (such as the flu or pneumonia shot), cancer screenings, mammograms and more.

Selecting a Medicare plan

Remember, there could be numerous Medicare plans in your area, with each plan offering a different level of coverage and cost. When choosing Medicare prescription drug coverage, it is important to know that Medicare covers part of the cost and the insured pays part of the costs. These costs, again, depend on the plan your loved one chooses. When comparing plans, you may want to use the Medicare Plan Finder. This online tool provided by allows you to compare plans in your area.

If your loved one doesn’t require any plan changes, there are no actions required for enrollment to continue. However, if changes are necessary, make them as soon as possible so your loved one doesn’t experience any issues at the pharmacy beginning in January, 2012.


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2 Comments to “Medicare open enrollment: review your elder’s plan today”

  1. Thanks for the comment, Kaye,
    Open enrollment can be a confusing time for elders, especially when they wonder if they must do something even if they are satisfied with their policies. The mailings from insurance companies are unending, and that confuses them even more. That’s why I like to remind caregivers to check with their elders about the state of their Medicare. We don’t want confusion to mess up what was fine to begin with! Also, of course, with medication changes, sometimes it’s better to change policies. This is complicated enough for the adult children to figure out.
    Take care,

  2. Kaye Swain

    Thanks for the helpful article. Medicare can be very confusing to so many and I know this will be a big help to boomers and seniors figuring out what they need to do, as well as helping their aging parents they may be caring for. Thank you.

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