Medicare 2012…What you need to know during open enrollment

(Family Features), October 12, 2011-- Medicare is different this year because of health care reform, and if you’re not aware of how this important program has changed, pay attention.

Be aware of deductibles, co-insurance, out-of-pocket limits and prescription drug costs

If you’re new to Medicare it’s important to know that both parts of Original Medicare (A and B) have deductibles. And, the Part A deductibles are not tied to a calendar year. Instead, they’re tied to a 90-day benefit period, with some exceptions.

The Medicare Part B benefit also includes coinsurance after you meet your deductible. With coinsurance, Medicare pays a percentage of each bill and you pay the rest (between 20 and 45 percent, depending on the service), after applicable premiums and deductibles.

New and existing benefits to help you fill in Medicare’s gaps

People concerned about some of the gaps in original Medicare have the option to enroll in insurance products regulated by the government but provided by private companies. These are products designed specifically to fill some of the different gaps in Medicare.

They include:

—Medicare Part D stand-alone prescription drug plans, which cover the cost of most prescription drugs.

—Medicare Supplement plans, which cover portions of the deductibles, coinsurance and out-of-pocket costs not covered by original Medicare.

—Medicare Advantage plans, which bundle together the Part D drug benefit with some additional coverage for deductibles, coinsurance and out-of-pocket costs.

Each type of supplemental coverage has different guidelines for when you can enroll, change and cancel your coverage.

There are new Medicare annual enrollment dates

Most beneficiaries can change a Medicare Advantage plan or stand-alone Medicare prescription drug plan once per year during Medicare’s annual enrollment period (AEP).  The dates for AEP run from October 15 to December 7 in 2011.

Medicare Supplement plans have an initial enrollment period, which occurs in the first 6 months after you enroll in Medicare Part B and are 65 or older. During that time, you can enroll in a Medicare Supplement plan and not be declined. But, if you try to enroll after the initial enrollment period, your application could be declined based on a review of your medical history.

But, if you want to switch from a Supplement plan to an Advantage plan, the AEP is a good time to make that switch.

It’s critical to compare drug coverage every year

PlanPrescriber.com, an internet company that allows people to compare Medicare plans side-by-side, looked at 25,000 user sessions on its website between November 15, 2010 and December 31, 2010.

The site found that, on average, a user could save over $500 per year — over $40 per month — by reviewing their options and changing their prescription drug plan.

Get star power in 2012

The Affordable Care Act requires a star rating system to be used for Medicare Advantage plans, beginning in 2012. Plans get a rating of 1 to 5, with a 5 star rating equating to an “Excellent Performance,” and a 1 star rating equating to a “Poor Performance.”

If you’re lucky enough to have access to a 5 star plan, consider it as an option for your coverage. One benefit of a 5 star plan is that you can enroll at any time, even outside of Medicare’s annual enrollment period.