April 19, 2011
2011 Changes for Medicare Advantage
Medicare Advantage - Changes in Part C for 2011
In March 2010, two new Health Care Reform laws (Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010) created a few changes in Medicare Advantage (Medicare Part C) plans to be effective in 2011.
Here are the highlights of those changes in Medicare Part C:
Cost sharing for certain benefits cannot be higher than Original Medicare.
Medicare Advantage Plans cannot impose higher out-of-pocket costs than Original Medicare for chemotherapy, dialysis, and skilled nursing care. Out-of-pocket costs can include a flat-dollar copayment, a percentage of the bill (called coinsurance) and/or a deductible, which you must pay first before benefits begin under the plan. These cost-sharing requirements must be the same as Original Medicare or better.
This is the first phase of a step-down plan to eventually bring Medicare Advantage premiums closer to what you would pay for Original Medicare in your county. The laws also give the Centers for Medicare and Medicaid Services (CMS) the authority to gradually adjust health risk scores, which is the method used to calculate premiums based on health status.
Some plans must prioritize wellness and certain extra benefits.
If a Medicare Advantage plan includes extra benefits that are not covered under Original Medicare, the plan must place an emphasis on reducing out-of-pocket costs, covering preventive care and providing wellness programs. This helps to ensure that your Medicare Advantage plan is at least as good as Original Medicare and worth the money you spend for your premium.
You have 45 days to change your mind.
One of the changes in Medicare Part C in 2011 includes a 45-day period in which you can change your mind. This period of time is called Medicare Annual Disenrollment Period lasting from January 1 to February 14. If you're not satisfied with your Medicare Advantage Plan, you have 45 days at the beginning of the policy year to switch back to Original Medicare and, if necessary, a qualified prescription drug plan. You cannot, however, switch from one Medicare Advantage Plan to another during this time.
Secretary of HHS has the authority to set rules for certain prescription drug coverage.
This is not a change in benefits, but rather a potential for change in how an insurer covers certain prescription drugs. Currently, there are six classes of clinical concern for prescription drugs. They are: anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals and immunosuppressants. The new law gives the Secretary of Health and Human Services the authority to change these classes and create exceptions to the classes as your insurance company would list them on your plan's formulary.
In addition, Medicare Advantage Prescription Drug plans may provide increased benefits or coverage to help reduce the prescription drug coverage gap.
Your Medicare Advantage Plan premiums will not increase in 2011.
Medicare Part C insurers cannot increase your payment rates. Medicare Advantage in 2011 will cost the same amount you paid in 2010. This price freeze includes plans that are new in 2011 at the 2010 rates.
The Special Needs program is extended until 2014.
Medicare Advantage Special Needs Plans (SNPs) will be available to all eligible beneficiaries for three more years. For those enrolled in an SNP and have both Medicare and Medicaid, these plans will be allowed to continue operating without established contracts with state Medicaid until 2013. In addition, starting in 2012, SNPs will need to be approved by the National Committee of Quality Assurance.
Annual election period for Medicare Advantage in 2011 (for 2012) plans is changing from November 15 through December 31 to October 15 through December 7. This change in enrollment dates will continue in future years.
