The bright national spotlight on the Affordable Care Act is shifting attention from another major health care event that affects 49 million Americans.
Medicare's open enrollment season is just around the corner.
From Oct. 15 to Dec. 7, anyone already enrolled in the government-backed senior health and drug plans has the option to change coverage without restriction. While it's an opportunity for Americans 65 and older to shop around for coverage, those satisfied with their policies can just stay put for 2014.
“If you are happy with where you are and your health, good for you,” said Michele Manzo-Lembo , a volunteer Medicare counselor at the West Central Florida Area Agency on Aging. “You don't have to do anything.”
The enrollment period this year affects more than 3.5 million Floridians, some of whom wonder if Medicare is now part of the Affordable Care Act's new health insurance marketplace, which opens for business Tuesday. The answer is no, said Nicole Duritz, AARP vice president for health education and outreach.
Medicare is not part of the marketplace, and eligibility rules for the senior health and prescription drug coverage remain the same, she said.
“Whether you are 65, 75 or 95, your Medicare is there for you,” Duritz said.
The open enrollment period is an excellent time to review both medical and drug plans, starting with your “Annual Notice of Change,” a statement that insurance carriers must send to their customers. The notices are required to arrive by Monday.
“It's a health care checkup,” said Patricia Henderson, community services coordinator at the Agency on Aging, which sponsors free Medicare counseling through its SHINE program. “We encourage people to look at their plan.”
This checkup applies to individuals who have Original Medicare and supplemental coverage (aka Medigap), as well as the 1.3 million Floridians who opt for Medicare Advantage plans run by private insurance companies. Henderson said it's especially important to review the list of covered drugs and note any changes to that coverage, often called Medicare Part D.
Most people automatically think about changes to the bottom line: premiums, co-payments and deductibles. But insurance companies may not include your doctors or preferred hospital in their network for the coming year. And the charges for prescription drugs may differ.
And don't forget that your medical needs also change from year to year, said Dani Gray, volunteer manager for the Tampa-area SHINE program. Shopping for Medicare is a laborious process that engulfs seniors, but it's important.
“When you go through something traumatic or overwhelming, you don't want to go through it again,” Gray said. “But we aren't the same people we were 10 years ago … our bodies change. Our needs change.”
Overwhelming is an understatement. Florida offers 318 different Medicare Advantage plans and 35 Medicare prescription drug plans, according to the Centers for Medicare & Medicaid Services.
Most seniors will start seeing the marketing surge from these plans in their mailboxes, on TV and in their morning paper starting Tuesday. Luckily, there are plenty of resources available to help sort it all out.
Online, the official government site www.medicare.gov allows you to search for health and drug plans based on your ZIP code. It also will compare several different plans side by side and shares customer satisfaction ratings. Wait until Oct. 8 to check that out, as a new round of quality ratings are scheduled to be announced.
The independent Medicare Rights Center says while these resources are excellent, consumers should follow up with their own doctors, hospitals and pharmacies directly to be sure the people and providers they want will be covered under their plan.
Locally, the SHINE program will be holding dozens of workshops, information sessions and enrollment events, Gray said. Also, seniors anywhere in Florida can call (800) 963-5337 and ask to speak with a Medicare counselor. You can talk over the phone or set up an in-person appointment with a volunteer counselor, unaffiliated with any insurance company, Gray said.
“We never ever say you should enroll in this plan or that one,” she said. “We educate you so you can make an educated decision.”
It will be a few more days before insurance companies release specifics of their Medicare Advantage plans, but large Tampa-area carriers, including Humana and Florida Blue, said they do expect to launch some new plans. Monthly premium rates also have not been released, though Medicare did announce the national prescription drug plan premium will remain about $30 next year.
While the Affordable Care Act doesn't change how Medicare recipients get their insurance, the 2,000-page law did include some significant tweaks that will continue in 2014.
In particular, seniors will bear a lesser drug cost burden in 2014, Duritz said. The dreaded “doughnut hole,” where seniors used to pay all medication costs at a certain level, will continue to include discounts started in 2013.
Next year, seniors in the doughnut hole will pay 47.5 percent of brand name drug costs, and 72 percent of generic drug costs. The discounts will continue to increase until 2019, Duritz said.
Also new: Preventative screenings, including cancer screenings and mammograms, will continue to be covered 100 percent for Medicare recipients. Officials say more than 1.4 million Original Medicare recipients have taken advantage of such screenings so far.
However, not all seniors will be happy with changes within the health law. Seniors with an annual income of more than $85,000, or $130,000 for a couple, will see higher Medicare premiums starting in 2014.
Manzo-Lembo, the SHINE counselor, said she's hoping everybody with Medicare takes the time to review their policy and changes. The new health law may not be changing your policy, but there are plenty of other reasons to do your homework and get the policy that works best for you.
“You always want to shop around,” she said.