Many Medicare Enrollment Options Still Open

Although the annual enrollment period for 2010 Medicare elections ended last week, there is a secondary open enrollment window when many choices still can be made. Medicare calls it an open enrollment period for Medicare Advantage plans but it can involve traditional Medicare coverage as well. And even when this window closes at the end of March, you may be able to make certain coverage changes until the 2011 annual enrollment period begins on November 15.

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From Jan. 1 through March 31, "Medicare recipients generally can switch plans if they do not change the status of their prescription drug coverage," according to Allsup, a company that sells Social Security disability and Medicare advisory services to consumers. Prescription drugs are covered through either Part D of the basic Medicare program or through a Medicare Advantage policy.

Thus, if you had drug coverage at the end of 2009, your switching choices must include continuation of drug coverage. Likewise, if you did not have such coverage, you can't elect to begin it during the open enrollment period. This leaves people with four sets of choices:

1. If you have a Medicare Advantage plan with drug coverage, you can switch to a different Medicare Advantage program with prescription coverage, or you can switch to traditional Medicare and also purchase Part D coverage for prescriptions.
2. If you have Medicare Advantage without drug coverage, you can switch to another Medicare Advantage Program or traditional Medicare but only if you do not add drug coverage.
3. If you have traditional Medicare with Part D coverage for prescription drugs, you can switch to a Medicare Advantage policy that includes drug coverage.
4. If you have traditional Medicare without Part D coverage, you can switch to a Medicare Advantage program but only if you do not include drug coverage in the new policy.

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Making a sound decision about Medicare coverage has never been easy. But the choices were especially complicated for 2010 plans. Big premium increases were applied to many private plans and some insurers stopped offering fee-for-service plans in many states because of changes in federal reimbursement rules. Most Medicare participants do not change their coverage from year to year. However, changes in coverage options, particularly for prescription drugs, make it likely that many people should seek new Medicare coverage that is cheaper and better meets their medical needs.

Paul Gada, who manages the Medicare advisory service offered by Allsup, says he has been inundated with E-mails from adult children who were visiting their parents over the holidays; they were frustrated with last-minute enrollment decisions. "The people that we've found going through our service are simply overwhelmed with the large number of plans that are out there, the choices [for coverage], and trying to navigate the system," he says. "Once they start exploring their options, it's like trying to do your own taxes multiplied by 10 or 20 times" the difficulty. Allsup has turned this complexity into a growing business, and charges people about $200 to help them make the best coverage decision during a single enrollment cycle.

Some people may simply have procrastinated and missed last year's enrollment deadline. But many others have simply never had to file a claim under their plans, and thus aren't aware how the coverage terms have changed since they first got a policy, Gada notes. One other specific reason to look at coverage options in 2010 involves people who are prescribed a new medication. They should review coverage options for that drug using an online Medicare tool, and see if there's a better drug plan for their changed prescription needs.

After March 31, Allsup advises, Medicare changes generally are restricted to:

•     People moving out of a plan's coverage area;
•     Those who turn 65 or have been disabled for more than two years (there's a 90-day window on each side of the qualifying dates);
•     Patients who enter, reside in, or leave a nursing home can enroll in Medicare anytime in the year;
•     Low-income recipients may be able to change plans as well.

[See 2010 Medicare Drug Plans Need Careful Study.]

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