2012 Medicare Changes

2012 Medicare Changes to the Annual Enrollment Period

While traditionally the Annual Enrollment Period has been from November 15 to December 31, starting in 2011, the Annual Enrollment Period will be from October 15 to December 7.

2012 Medicare Changes and the Special Election Period (SEP) for Enrollment in 5-Star MA Plans and PDPs

As part of the 2012 Medicare changes, this new SEP will be available starting December 8, 2011. The SEP has been established by the Centers for Medicare and Medicaid Services (CMS) to allow Medicare beneficiaries to enroll in a 5-star Medicare Advantage (MA) plan, Prescription Drug Plan (PDP), or Medicare Advantage Prescription Drug Plan (MAPDs) at any point during the year.

This overall plan summary rating is provided by CMS prior to the Annual Election Period and has been since before the 2012 Medicare changes. Any beneficiary who requests enrollment into a 5-star plan after the 2012 Medicare changes will be enrolled the month after the request has been received. Because the summary rating is effective for a contract year (January - December), the effective dates of enrollment requests using the SEP are limited to January 1 through December 1 of the year the plan has the 5-star rating.

A plan must have the overall plan summary rating to qualify with these 2012 Medicare changes. Even if a plan has received 5-stars in some rating categories, if it does not have an overall 5-star rating, it will not qualify with the 2012 Medicare changes.

Beneficiaries are limited to using the SEP once in the year. Once they use the SEP to enroll in a 5-star plan they will once again be limited to making changes only during other applicable periods not affected by the 2012 Medicare changes, such as the Annual Enrollment Period.

The SEP does not convey any additional right to select other coverage outside the normal enrollment periods unaffected by the 2012 Medicare changes. If beneficiaries leave an MAPD to enroll in a 5-star PDP without health coverage OR a 5-star MA plan without prescription drug coverage, they will be unable to complement their coverage with a separate plan until the next valid enrollment period according to the 2012 Medicare changes.

These 5-star plans have been informed of these 2012 Medicare changes and will be required to accept these SEP requests until the plan closes due to a CMS-approved capacity limit.

2012 Medicare Changes to the Coverage Gap in Medicare Part D

Even before the 2012 Medicare changes, beneficiaries have had to pay all prescription costs out-of-pocket once they and their drug plans spent a certain amount of money for covered drugs. This is the coverage gap, also known as the "donut" hole. The 2012 Medicare changes have changed the amount paid before reaching the coverage gap, known as the Medicare Part D initial coverage limit, to $2,930, raising it from $2,840 in 2011.

Beneficiaries in the coverage gap will continue to receive a 50% discount on their covered brand name drugs, and will pay 93% for plan covered generics, despite the 2012 Medicare changes. There are plans that cover beneficiaries during the coverage gap, but they may charge higher monthly premiums. Beneficiaries with Medicare Part D Extra Help do not have a coverage gap.

Beneficiaries will leave the coverage gap once they have reached the Medicare Part D maximum out of pocket limit. The yearly deductible, coinsurance or copayments, and everything that was paid while in the coverage gap all count towards this limit. The drug plan premium or payments on drugs that aren't covered are not included in the limit. The 2012 Medicare changes have raised the Part D maximum out of pocket limit to $4,700, up from $4,550 in 2011.

Other Important 2012 Medicare Changes

The Medicare Part D deductible has been raised to $320 from $310 in 2011.

The Medicare and You Handbooks will be mailed September 15, 2011 instead of in October.

The Annual Notice of Change must be sent to beneficiaries by September 30, 2011.