Oct 16, 2011

Start shopping now for Medicare plan or you may lose out

Start shopping now for Medicare plan or you may lose out
Experts fear some seniors will miss early deadline Dec. 7

By Bob LaMendola, Sun Sentinel

October 16, 2011

No pressure, but seniors and disabled people can't delay this fall when it comes to choosing a Medicare plan for 2012.

The signup deadline was moved ahead by about three weeks this year, to Dec. 7, to give Medicare and health insurance plans more time to finish your paperwork before the new coverage starts on Jan. 1.

The good news is seniors can start signing up immediately. Coral Springs retiree Lillian Martel, 81, is shopping because her plan charges a high co-payment for specialist doctors.

"I don't like paying a specialist. My girlfriend doesn't mind paying a specialist. Everyone wants something different so you have to look for what is best for you," Martel said. "I know all that comparing is a lot of work to do, but you have to do it."

The choice can be difficult. The half-million Medicare recipients in Broward and Palm Beach counties must sort through more than 100 health plans and prescription drug plans this year. The 400,000 in Central Florida pick from as many as 90.

Here's a rundown for 2012:

What's new this year?

The early deadline worries some experts. They predict some seniors will miss it. So far, Medicare has devised no back-up plan for those who fail to pick a plan on time, making it possible seniors will be bumped back to traditional Medicare — without drug coverage.

A survey in July and August by PlanPrescriber.com found that only 35 percent of seniors knew the signup period was ending early.

Q: Can seniors still change health plans after Jan. 1?

A: Yes, but not the way they have in the past. Those who don't like the health plan they choose will have until Feb. 14 to switch, but only to traditional Medicare. They will be allowed to sign up for a drugs-only plan to supplement Medicare.

Q: Any other new features?

A: Medicare rated HMO-style health plans from one star (lowest) to five stars (best). For the first time in 2012, Medicare will reward the best plans by allowing seniors to switch once during 2012 into a five-star plan.

But this won't help Floridians, since only nine of 569 health plans in the country were rated 5 stars, and none of the nine are in Florida.

Also, Medicare plans must offer more preventive services for free, including annual checkups.

Q: What about drug prices?

A: Health and drug plans must offer higher discounts on generic drugs for seniors who reach the "doughnut hole." That's the period when Medicare and insurers stop covering the cost of drugs and seniors pay for their own drug costs.

Next year, the discount on generics will be 14 percent, compared with 7 percent this year. The discount on brand-name drugs remains at 50 percent.

Q: Anything else about the doughnut hole?

A: Seniors will have to spend more to get themselves out of the coverage gap in 2012.

The gap starts when the total amount spent on drugs — by you and the plan — reaches $2,930. That's $90 more than this year. The gap stops after you spend $4,700 total on prescriptions, up from $4,550 at present.

Q: What's new with prescription drug plans?

A: Floridians can choose from among 33 prescription drug plans, one more than this year. Premiums range from $15.10 to $125 a month, about the same. The average cost fell about 50 cents to $54.36 a month.

The low-price leader remains Humana's Walmart Preferred Rx plan, one of only three plans costing less than $25 a month.

Insurers have dropped some of the mid-priced plans that carried extra coverage. Ten of the 33 plans offer limited drug coverage to people who reach the coverage gap, but the premiums in those plans cost at least $56.20 a month.

Only one plan offers any coverage in the gap for brand-name drugs. That's Coventry First Health Premier Plus. The monthly price of the plan jumped to $96.30 from $81.

Q: What's new with Medicare health plans?

A: The HMO-style plans remain highly popular, the choice of about one-third of Floridians on Medicare — almost half in Broward and Osceola counties, among others.

Medicare officials expect them to get even more popular. They said monthly premiums are falling by an average of 4 percent on health plans, and they predict HMO enrollment will swell by 10 percent next year. This has limited impact in Florida, where about two-thirds of plans charge no premium.

In Central Florida, the landscape remains fairly steady for 2012. Seniors can choose from as many as 60 plans, about the same as now.

Insurers, under pressure from Medicare, are dropping duplicative plans. Palm Beach County will have 60 plans, Broward 77 — both down from 90. Experts said seniors lose little except clutter from very similar plans.

Some plans are cutting benefits. In Broward County, only 16 plans will pay all or part of your Medicare Part B premium as an enticement to get you to join. That's down from 24 this year. In Palm Beach County, 10 will pay, compared with 16 this year.

Three dozen plans in South Florida will cover some drugs in the coverage gap, down from 41 last year. In Central Florida, the number held steady at 21.

Q: What about deductibles and co-payments?

A: Generally, these remained about the same, but some plans have raised the prices that consumers pay for prescriptions, doctor visits, hospital stays and other care.

The government will allow drug and health plans to raise the deductible for drug coverage by $10 a year, to $320. But few plans elect to charge a deductible.

blamendola@tribune.com or 954-356-4526