A Medicare Expert Answers Your Questions

ThirdAge Interviews A Medicare Expert

Since the enrollment period for Medicare began just last Saturday, ThirdAge decided to speak to Carolina Fortin-Garcia, Public Affairs Specialist at the Centers for Medicare & Medicaid Services to help answer  the questions you may be having about Medicare this year. 

The open enrollment period for Medicare participants has changed.   Why did It change and what is it now?

The Annual Election Period (AEP), also called the fall open enrollment period, has new dates this year. It begins on October 15 and runs through December 7.  2012. Plan information was available starting on October 1 at 1-800-MEDICARE and www.medicare.gov.  

The new dates for the AEP were mandated by law (the Affordable Care Act) in order to give people more time to choose a plan and to permit a smoother transition to their new plan.  The new time frame should better ensure that people have their new membership cards in hand at the beginning of the year. Also, Open Enrollment lasts longer (7 full weeks) to give people enough time to review and make changes to their coverage. This change ensures Medicare has enough time to process your choice, so your coverage can begin without interruption on January 

During open enrollment a Medicare recipient is bombarded by offers from insurance companies. What should they be looking for in the offers?  How do they find the best plan for themselves? 

Medicare has a number of tools and resources available to help consumers compare health and drug options, including updated information available at 1-800-MEDICARE and www.medicare.gov.  For example, the Quality Care Finder in medicare.gov can help beneficiaries find and compare health and drug plans. This useful data helps you compare information about the quality of care and services plans offer.  Beneficiaries also get helpful tips on what to look for when comparing and choosing a plan. What are the biggest changes this year in Medicare? CMS continues to make it easier for beneficiaries to find and choose high quality plans. As of October 12, the Medicare Plan Finder includes the plans’ 5-Star quality rating. In addition to the star ratings, users will find an icon that shows those plans that had a low overall quality rating the past three years and, new in 2012, will also see a gold star icon that shows those plans that have a five star rating for 2012.  Also new in 2012, individuals will have a special enrollment period to enroll in a 5-Star Medicare Advantage or Part D plan in their area. This SEP allows an individual to switch or join a 5-Star plan at any time during the year, however they can only use this SEP one time annually.  Five-Star Medicare Advantage and Part D plans are permitted to continuously market and enroll beneficiaries throughout the year in which they have the 5-star rating.  
This year, as beneficiaries look over their available plan options, they will see better value in the Medicare Advantage (Part C) and Prescription Drug (Part D) plan benefits.  All beneficiaries will have access to Medicare-covered preventive services at zero cost-sharing, including an Annual Wellness Visit.  Those in the Part D coverage gap, or donut hole, will receive 50 percent discounts on covered brand name drugs thanks to the Affordable Care Act.  On average, Medicare Advantage premiums will be four percent lower in 2012 than in 2011, and plans expect enrollment to increase by 10 percent. Average premiums for Part D prescription drug plans will also decrease to $30 in 2012, about 76 cents less compared to the average 2011 premium.  The premium amount is based on bids submitted by Part D plans for the 2012 plan year.   Benefits in 2012 remain consistent with those offered in 2011. What confuses people the most about Medicare enrollment?  How does the CMS help make things clearer? With Open Enrollment coming early this year, it is important that people with Medicare take advantage of the next weeks to review their current coverage and compare it with the options that are available for next year.  The information that’s available now on the Plan Finder will also help caregivers, health providers, and partners that support and counsel seniors and people with disabilities in selecting the best plan for their needs.
Are there some little tips for Medicare recipients?  Like what is the best time to call for information?  The best way to handle a bill one does not understand? Contacting their State Health Insurance Assistance Program (SHIP). Beneficiaries may call 1-800-MEDICARE to get the phone number of the local SHIP that can provide personalized one-on-one counseling.    What is the difference between Medigap and Medicare Advantage Plans? A Medigap policy (also called “Medicare Supplement Insurance”) is private health insurance that is designed to supplement Original Medicare. This means it helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits. Note: Medicare doesn’t pay any of the costs for you to get a Medigap policy.
Every Medigap policy must follow Federal and state laws designed to protect you, and the policy must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies in most states can only sell you a “standardized” Medigap policy identified by letters A through N. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies. Medicare Advantage Plans (like an HMO or PPO) are health plans run by Medicare approved private insurance companies. Medicare Advantage Plans (also called "Part C") include Part A, Part B, and usually other coverage like Medicare prescription drug coverage (Part D), sometimes for an extra cost. What are the most common Medicare scams?  How can one report a scam? The following are examples of possible Medicare fraud: A health care provider bills Medicare for services you never received. A supplier bills Medicare for equipment you never got. Someone uses another person’s Medicare card to get medical care, supplies, or equipment. Someone bills Medicare for home medical equipment after it has been returned.
A company offers a Medicare drug plan that has not been approved by Medicare. A company uses false information to mislead you into joining a Medicare plan. To learn more about CMS fraud prevention and ways to protect against it, visit www.stopmedicarefraud.gov.  More information is available at www.healthcare.gov, a new web portal made available by the U.S. Department of Health and Human Services. Review your Medicare or other health care claims statements. For people with Medicare, you can do this by going online at www.MyMedicare.gov or by calling 1-800-MEDICARE and using the automated telephone system to make sure you received each service listed and that all the details are correct.  All health care consumers should report suspected instances of fraud by calling 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).  Sending an email with details of what happened to Surveillance@cms.hhs.gov. How can one find the best Part D or prescription drug plan for themselves? People can use the Plan Finder – available at www.Medicare.gov  – by inserting their home zip code to find out which Medicare Advantage (Part C) and Prescription Drug (Part D) plans are available in their areas.  If the zip code search shows multiple counties it will prompt users to select one county to continue the search.
For 2010, the Plan Finder was the most popular tool on www.Medicare.gov, with more than 280 million page views.  Also available online is Medicare’s Formulary Finder, which allows beneficiaries to insert their prescribed medications and zip code to see a display of plans offered locally that cover their drugs.  What will the Medicare cutbacks that are envisioned in the Health Care bill that was passed last year effect an individual?   Read the Medicare blog by Don Berwick, M.D., Administrator, CMS, for some good insight about this. What are the Medicare treatments like certain screening tests that people don’t take advantage of? The "Welcome to Medicare" preventive visit helps you and your doctor develop a personalized plan to prevent disease, improve your health, and help you stay well. A few things you should know: It's free. There’s no copayment or deductible for the visit. It’s easy to use this benefit. Just call your doctor when you sign up for Medicare. You can sign up for the visit during the first 12 months you have Medicare. After the first year, you can get a yearly “Wellness” visit for free. It’s comprehensive. The visit includes a review of your medical history; preventive tests and screenings; and planning for a healthy future. The visit is covered by Original Medicare (Part B) and Medicare Advantage Plans. Under the new healthcare law, the visit is now free to those with Original Medicare, and to most people with Medicare Advantage Plans, along with a number of preventive screenings and services (like mammograms and colonoscopies). Do Medicare forms drive you nuts? Share your frustrations here.    
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