People 65 and older have less than a week to sign up for a Medicare Advantage plan or a prescription-drug plan by the Dec. 7 deadline.
The deadline was moved up last year from Dec. 31 to early December. The earlier deadline gives private insurers more time to enroll new customers before the plans take effect on Jan. 1, 2013.
Medicare is often referred to by its parts: A, B, C and D. When a person turns 65, he or she is eligible for the federally funded health-care plan. Medicare A is hospital coverage and Medicare B is medical insurance that covers doctor visits and specialists.
Some people choose to enroll in a Medicare Advantage plan — Medicare Part C — to get extra benefits provided by a private health insurer, and the insurer is paid by the federal government. Separately, some people may choose to pay for a prescription drug plan, Medicare Part D. Some Medicare Advantage plans also include drug coverage.
Medicare Advantage, Part C, is a privately run version of parts A and B.
“It’s basically, yes, a private insurance company that’s now covering the Part A, and the Part B and additional benefits that the plans may have,” said Raymond Hurd, acting regional administrator in the Northeast, including Connecticut, for the U.S. Centers for Medicare & Medicaid Services.
“Medicare Part B for out-patient only covers those medically necessary procedures,” Hurd said. “If a person wants something like … maybe they want to join a gym, you’re not going to get that strictly from Part A and Part B. But you may find a Medicare Advantage plan that offers that as a benefit.”
A key aspect of shopping for Medicare Advantage plans is finding which services the insurer is providing above and beyond the standard-issue government versions of Medicare parts A and B.
In Connecticut, about 259,000 people — or 43 percent of Medicare recipients — sign up for Part D plans. Health insurers in Connecticut offer 30 Medicare Part D plans for drug coverage ranging in price from $15 to $109.50 per month, which doesn’t include co-pays and deductibles. Most plans have a premium of less than $40.
Medicare Advantage plans available next year are priced at a range of $0 to $209 per month. The “free” plans are still funded by the federal government, which is to say, taxpayers.
New in 2013, Medicare Part D plans will cover new drugs, such as benzodiazepines for treating anxiety, insomnia, agitation, seizures, muscle spasms and alcohol withdrawal, as well as barbiturates.
Medicare policy also changes the amount customers pay for prescription drugs, including a reduction in how much they pay while they are in a gap in coverage, often called the “doughnut hole.”
For prescription drug coverage in Medicare Part D, a customer pays premiums all year and the first $325 deductible. After the deductible, the customers pays 25 percent of the cost of drugs, and the health plan pays the rest, until the total amount spent by the customer and the insurer reaches $2,970. Then the doughnut hole begins. Traditionally, that meant that customers had to pay 100 percent of the cost of drugs until they had spent so much that “catastrophic” coverage kicked in and paid most of the remaining drug costs for the year.
New in 2013, however, Medicare recipients are paying less for brand-name prescription drugs while they are in the “doughnut hole.” Next year, customers will pay 47.5 percent of brand-name prescription drugs — down from 50 percent this year, or 100 percent before federal health care reform. For generic drugs, customers will pay 79 percent of the cost next year, down from 86 percent this year, while they are in the “doughnut hole.”
The “doughnut hole” in coverage ends when a customer has spent a sum of $4,750 out of pocket. After that, the customer only has to pay $2.65 for a 30-day supply of a generic drug and $6.60 for a 30-day supply of a brand-name drug.
Anyone who needs assistance selecting a plan may call CHOICES, Connecticut’s program for Health insurance assistance, Outreach, Information and referral, Counseling, Eligibility, Screening, at 800-994-9422.
People call CHOICES to clarify information and to get guidance while choosing a plan on Medicare.gov, said Sandy Leubner, statewide coordinator for the CHOICES program.
“It’s a highly customized approach,” she said of Medicare’s online plan finder, which is available at https://www.medicare.gov/find-a-plan/questions/home.aspx.
Connecticut had 586,749 Medicare members as of May, the most recent month for which statistics are available. Hartford County had the greatest share — 26 percent or 152,329, followed by New Haven County with 25 percent ,or 144,256 and Fairfield County with 23 percent, or 137,373.
Medicare enrollment is growing as baby boomers reach the eligibility age. For example, the number of Medicare recipients in Connecticut is up 6.6 percent this year compared with 550,217 in 2009.
People who don’t enroll in a Part C or Part D plan by the deadline are automatically enrolled in their current plan next year, but only if the plan is available. Medicare officials sent notices earlier this fall to people who don’t have that option.