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Federal Government Open Enrollment: Medicare

October and November are traditionally the months when large employers offer employees the opportunity to enroll in benefits for the coming year. These plans may include 401ks, other retirement programs, and of course, health insurance. Many open enrollments include several benefits fairs that give a chance for providers to showcase their offerings so that employees can learn about what is available and what works best for them. Most employers will distribute materials that describe changes in health care coverage. Employees are almost always confused, and with the rollout of health care reform, many are traumatized.

Medicare open enrollment runs from November 15th to December 31st. The same open enrollment window applies to Part D as well. Although the Patient Protection and Affordable Care Act was intended to assist seniors and reduce their skyrocketing medical costs, this may not be the case. In the absence of a benefits fair, seniors need to conduct their own research among a variety of sources: online tools, toll free phone lines, and direct mail solicitation. While most of these modifications are effective years from now, many private insurance companies are reducing and eliminating some benefits now.

Selecting a Part D plan can be a challenge for even the savviest senior. Often original Medicare participants have more than 25 plans to choose from, each with different coverage and premiums. After assessing the cost, individuals should be sure that prescription drugs are covered by the plan. If they aren’t covered, all additional expenses will be out-of-pocket so it may make sense to enroll in a different plan. It is also important to be sure that there is no limit on the amount of a drug that a physician can prescribe so as to avoid extra expenses. Participants in employer sponsored post retirement health plans should look at drug benefit carefully before year end.

Part D has some key changes in 2011. Participants with income higher that $85,000 for individuals or $170,000 for joint filers will have higher premiums than those with lower income. Social Security is tasked with providing notification to those who are eligible for this increase. Also, the process of closing the doughnut hole begins in 2011 so that there will be some relief for individuals that reach the gap.

Medicare has been confusing since it was created, and that isn’t likely to change. That said, it is critical for retirees and pre retirees to do a careful evaluation of the available alternatives. Please contact Ellen at EAB HealthWorks for more information.