Changes to Medicare for 2011 Its time to decide &enroll

Published 1:24 pm Friday, October 15, 2010

Well, its decision time for seniors who are considering changing their health coverage under Medicare as well as for those who are going to become eligible for Medicare in the next few months.&bsp; Some of the biggest questions youll face have to deal with choosing traditional Medicare or Medicare Advantage and the Part D Prescription Drug coverage. So lets take a look at whats happening to the current Medicare options.

For existing Medicare enrollees, the amount of time that you now have to review your options and reenroll or change coverage has been shortened, and you must either enroll or make changes to your current enrollment between November 15, 2010 and December 31, 2010, because as of January 1, 2011, enrollment is closed.

Unlike previous years, as of 2011 you wont be able to switch to a different Medicare Advantage plan between January 1 and March 31. If you enroll in a Medicare Advantage plan during the Annual Enrollment Period, you have until February 15, 2011, to change your mind and disenroll. If you elect to disenroll, you will automatically be placed into Original Medicare (Parts A & B). If prescription drug coverage was part of your Medicare Advantage plan, you will be able to enroll in a Medicare Part D plan during this time.

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Be advised, Medicare Advantage is not going away. Some plans may be discontinued, and many of the remaining plans will have some changes made to your current benefits and there is a good chance your premiums will go up.&bsp; However, there will still be choices of HMOs, PPOs and Special Needs Plans among many of the ongoing Medicare Advantage plans.

Be aware that all Medicare Advantage plans will have an annual our-of-pocket maximum, which obviously varies by plan, but has a set maximum amount for 2011 of $6700.00.&bsp; Both traditional Medicare and Medicare Advantage plans will offer yearly screenings, preventative services and wellness visits at no additional charge other than your Part B premium.

Medicare beneficiaries will be paying different rates for Part B based on their last COLA increase – $96.40 for 2009 effective date and $110.50 for 2010 effectives.&bsp; If you are new to Medicare and expect to enroll for a 2011 effective date, you can expect to pay more for Medicare Part B than those already enrolled in the program.

Within Medicares Part D drug coverage, there is a coverage gap.&bsp; In 2010, the federal government authorized a 1-time $250.00 rebate for those who reached the coverage gap or Donut Hole.&bsp; There is no $250 available in 2010, but the amount you will have to pay our of pocket will begin to shrink beginning in 2011, but you will still incur out of pocket costs. &bsp;

In 2011, your Initial Deductible will remain $310, Initial Coverage Limit will go up to $2,840, and your Out-of-Pocket Threshold will remain $4,550.&bsp; This means that once you reach your Medicare Part D plans initial coverage limit of $2,840, you will have to pay 100% of your drug costs until you reach the upper threshold limit of a total of $4,550.

But there is some limited relief available. In 2011, Part D enrollees will receive a 50% discount on the total cost of their brand-name drugs while in the donut hole. The full retail cost of the drugs will still apply toward your upper out-of-pocket limit and exiting the donut hole even though half of your out of pocket expenses will be paid for your brand name drugs by the pharmaceutical manufacturers. Enrollees will pay a maximum of 93% co-pay on generic drugs while in the coverage gap.

For those who meet the criteria, the Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit will remain the greater of 5% or $2.50 for generic or preferred drug that is a multi-source drug and the greater of 5% or $6.30 for all other drugs in 2011, and Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees will remain $2.50 for generic or preferred drug that is a multi-source drug and $6.30 for all other drugs in 2011.

With so many changes being made, and even more modifications to Medicare Advantage plans and the Part D drug coverage, its a very good idea to start immediately on your plan analysis and review to be sure that you not only meet the December 31, 2010 enrollment deadline, but that you do so with the best plan you can find and afford that meets your needs.

For more information, visit or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week.

Ron Kauffman is a Certified Senior Advisor, radio talk show host and an expert on issues of aging and care giving. He is the author of Caring for a Loved One with Alzheimers Disease, which is available at He can be reached at 561-626-4481 or by email at