Open Enrollment is Here! Do You Know Your Plan Changes for 2014?

Open Enrollment is Here! Do You Know Your Plan Changes for 2014?

Open Enrollment is upon us. Technically referred to as the Annual Election Period (AEP), this enrollment period runs from October 15 through December 7, and is one of the few times you can change, enroll into or disenroll from a Medicare Advantage or Part D plan. Change is effective January 1, 2014. (Note: Medicare beneficiaries who have retiree health benefits from their union or former employer may have a different period for changing plans. Similarly, people who are covered by an employer plan based on their current employment or their spouse’s employment may have a different open enrollment period. Please contact the administrator of your employer’s plan for information.)

The AEP is not to be confused with the new open enrollment for Covered California, which is from October 1, 2013 through March 31, 2014. If you have Medicare, you do not need to buy coverage through Covered California. You already have insurance. You cannot buy Medicare Advantage plans, Part D prescription drug plans or Medigap insurance through Covered California.

Have you reviewed your plan’s changes for 2014?
If you are in a Medicare Advantage (MA) or Part D plan, make sure you review your plan’s changes for 2014. Each year plans can choose whether or not to renew their Medicare contract. If your plan is renewing, it should have already mailed you an Annual Notice of Change. This notice tells you how your plan will alter in the coming year, such as changes in the premium, copayments, deductibles and benefits.

Medicare announced in September that the average premium for MA plans was projected to increase by only $1.64 and that the average premium for Medicare Part D plans was projected to hold steady at $31 for the 4th year. Yet, the average may not be true for your plan. Beneficiaries who take time to review their plan’s changes and their other coverage options are more likely to save money and find a plan best suited for their needs, compared to beneficiaries who do not review and stay with their same plan.

If your plan is not renewing
If your MA or Part D plan is not renewing its contract with Medicare, you should have received notice by October 2nd. The notice informs you of your Special Election Period, from December 8, 2013 to February 28, 2014 to enroll in another MA or Part D plan offered in your area next year. You don’t have to wait until December 8 to choose your new plan; you can choose a new MA or Part D plan during the Annual Election Period. For more information, see When Medicare Advantage Plans Terminate Coverage.

Two stand-alone Part D plans will not be renewing next year in California. These are EnvisionRxPlus Gold and Humana Complete. As for Medicare Advantage, there will be more HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations) than in 2013 but fewer private fee-for-service (PFFS) plans. Contact your local Health Insurance Counseling and Advocacy Program (HICAP) for information on the plans available in your area.

Part D updates
The Part D prescription drug “donut hole” (or coverage gap) continues to shrink. For brand name drugs, your coinsurance is the same as for 2013: 47.5%. For generic drugs, the beneficiary coinsurance will decrease 7%, from 79% this year to 72% in 2014. (See our past article for more information on how the coverage gap discount program works and what costs are counted to one’s true out-of-pocket (TROOP) costs.)

2014 Part D Standard Plan costs

The chart below describes the standard Part D plan. Part D plans are allowed to vary but must offer coverage as good as or better than this standard plan. The deductible has decreased for 2014, which is the first-ever decrease since Part D drug coverage began in 2006.

Update on “automatic refill” services
Starting January 2014, Part D plans must require their network retail and mail-order pharmacies to obtain patient consent prior to delivering each prescription. This change is to help prevent or minimize waste. Too often beneficiaries have gotten automatic refill for prescriptions they no longer need.

New Explanation of Benefits for Medicare Advantage plans
As of January 1, 2014, Medicare Advantage (MA) plans are required to send enrollees an Explanation of Benefits (EoB) for their medical and hospital services. This MA EoB is different than the Part D EoBs that Medicare Advantage Prescription Drug plans (MA-PDs) and stand-alone Part D plans (PDPs) have been sending since 2006. The MA EoB provides information about claims for medical and hospital services, not drugs. If you are In an MA plan, make sure to review your EoB and confirm you did indeed receive the services. If you note any suspicious charges or services noted, call your plan and/or call our Senior Medicare Patrol at 855-613-7080.

Mental health parity is reached!
In 2014, Medicare reaches “mental health parity.” Medicare will provide the same coverage for outpatient mental health services as it does for other Part B services: 80% of the approved amount and beneficiaries will pay the remaining 20%. Before 2010, Medicare only covered 50% for outpatient mental health services.

Where to go for help
With so many changes happening, make sure you understand how they will affect you and review your coverage options for 2014 during the Annual Election Period. For help comparing options or finding another plan, please contact your local HICAP (Health Insurance Counseling & Advocacy Program), the Medicare benefits counseling program at 1-800-434-0222. Also, visit our Annual Election Period section for common Q&As about the AEP. Plan information is available on the Medicare Plan Finder at medicare.gov.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.