Shop earlier for Medicare plans this year

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Tom Murphy

A new deadline for Medicare Advantage plans — privately run versions of the government’s Medicare program — may trip up seniors who typically wait until the holidays to settle on their health insurance coverage for the coming year.

Medicare Advantage plans cover more than 11 million people. They offer basic Medicare coverage topped with extras, such as vision or dental coverage or premiums lower than standard Medicare rates.

Most beneficiaries enroll after they turn 65. Then they have an open enrollment window every fall in which they can drop their coverage and switch to another plan.

Deadlines moved up

Beneficiaries will receive their annual notice telling them about any changes in their coverage for next year by Sept. 30, which is a month earlier than last year. Insurers then will start marketing their 2012 plans on Oct. 1.

This fall’s open enrollment period for Medicare Advantage plans and Part D prescription drug coverage has been changed to Oct. 15 through Dec. 7. (Last year, it was from Nov. 15 through Dec. 31.)

Closing the enrollment period in early December aims to provide more time for applications to be processed by the end of the year. This should help prevent the problems many late deciders had last year in getting coverage started by January 1.

But the change could also create other problems for many beneficiaries.

Here are answers to some common questions.

Will the deadline changes affect many beneficiaries?

Medicare Advantage customers will have enough time to consider their options and enroll in another plan if they avoid waiting until the last minute, said Judith Stein, executive director of the Center for Medicare Advocacy.

But last-minute stragglers are common. Plans can receive as much as a quarter of the applications for coverage they normally get during open enrollment in those last three weeks of December, according to Matt Burns spokesman of UnitedHealth Group Inc., the largest Medicare Advantage coverage provider with more than 2 million customers.

Many people take time to make their coverage decisions. Beneficiaries start seeing Medicare Advantage ads in the fall. Then they might talk to their families, stew on the decision, and wait for the holidays to pass, said Dr. Jan Berger, chief medical officer at Silverlink Communications Inc., which works with Medicare Advantage providers.

What happens if you miss the deadline and make no changes?

This can get complicated.

If the plan is still offered for 2012, then a customer who doesn’t make any changes remains enrolled. But important aspects of that plan may change.

If the plan is discontinued, customers may be switched to another Medicare Advantage plan offered by the same insurer. The cost and coverage could be different.

They also could be dropped into regular Medicare, which does not provide prescription drug coverage.

Options do not completely dry up if a beneficiary misses the Dec. 7 deadline. From January 1 to February 14, Medicare Advantage customers can drop their plans and enroll in regular Medicare.

During this time, they also can pick a Part D prescription drug plan to go along with that coverage, but they can no longer jump to another Medicare Advantage plan (as used to be the case prior to this year).

Here’s another wrinkle: Beneficiaries can enroll any time during the year in a Medicare Advantage plan that has prescription drug coverage if they receive a low-income subsidy or if they have access to a plan with a five-star quality rating.

The catch: Only a few plans attained that rating for this year, said David Lipschutz, an attorney with the Center for Medicare Advocacy. The government will announce a new list of five-star rated plans sometime in October.

Should Medicare Advantage customers review their coverage even if they don’t plan to make changes?

Absolutely. Plans can change what they cover from year to year, and what they charge.

Customers may find that prescription drugs that were covered last year aren’t covered in the new year, or they may suddenly face a big bill for a costly treatment like chemotherapy that used to be covered. Any changes will be laid out in the annual notices consumers receive from their insurers.

“People really, really need to look carefully and not assume that because something worked last year it will work this year,” Stein said.

Local Senior Health Insurance Assistance Programs (SHIP) provide one-on-one assistance to help you understand the Medicare programs available to you and make a good choice. Their services are free.

In Baltimore City, call (410) 396-2273.

In Baltimore County, call (410) 887-2594.

— AP