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A little-known, under
publicized, Medicare open-enrollment period that begins this Sunday, April 1st,
could an unpleasant April Fool’s Day for seniors considering switching health
plans, experts warn. The period which opens on Sunday is Called the
"limited open enrollment period," and it allows people currently
enrolled in the traditional Medicare program to sign up for Medicare Advantage
plans that don't include drug coverage. Open enrollment runs from Sunday
through December. Many Medicare beneficiaries are not familiar with the
Medicare Advantage program and some senior advocates fear thousands of seniors
could lose their drug coverage or switch to more expensive health insurance if
they don't do their homework. Because some insurers are offering lower premiums
and co-pays as well as perks such as eye exams, hearing aids and acupuncture
treatments, there's ample incentive to switch. "This danger isn't being
widely publicized at all," said David Lipschutz, staff attorney with
California Health Advocates, which helps seniors understand Medicare benefits
told the Oakland Tribune.
By now, most of the nation's
43 million Medicare beneficiaries are well versed in the prescription drug
benefit, called Part D, that launched last year. Most eligible seniors and
disabled persons have chosen their drug plan and health providers, and won't
re-evaluate their benefits until open enrollment for Part D begins in November.
But for those unhappy with traditional Medicare — where patients pay premiums
and a percentage of fees — changing to Medicare Advantage is now an option.
Medicare Advantage plans are private health plans that provide physician
services, hospital visits and other health benefits to Medicare beneficiaries
and are subsidized by the federal government. It's another bite at the apple
for insurers," Lipschutz said. These plans are either Medicare HMOs —
where members are treated by a certain pool of physicians — or private
fee-for-service plans, PFFS, an increasingly popular option where Medicare
beneficiaries are not limited to an HMO network.
During the new enrollment
period starting Sunday, seniors with Part D drug coverage and traditional Medicare
who switch to a private fee-for-service plan will be able to retain their
previously selected Part D prescription drug benefit. However, those who switch
to a Medicare HMO that doesn't offer drug coverage will lose their Part D drug
benefit. If seniors lose their drug
coverage, not only will they be unable to get it back until 2008, but they will
have to pay penalties each month for dropping it. This unexpected
open-enrollment period was signed into law Dec. 20 by President Bush as part of
the Tax Relief and Health Care Act of 2006 — one of the last pieces of
legislation passed in the waning days of the Republican-controlled Congress.
The law itself is a wide-ranging trade and tax package that extended certain
tax breaks, approved offshore drilling on the Gulf Coast and included
provisions to improve trade relations with Vietnam. The open-enrollment period
is applicable only for this year and 2008, according to the law. Meanwhile,
Congress is taking a hard look at the price tag for Medicare Advantage plans.
Federal reimbursements for Medicare Advantage are 12 percent more than
traditional Medicare, according to the Medicare Payment Advisory Committee. The
Congressional Budget Office estimates that the government would be able to save
$65 billion over five years by cutting these subsidies. "All these plans are not the same," Rep. Pete Stark, D-Fremont
told the Oakland Trinue. Stark chairs the House Ways and Means subcommittee on
Health and convened a hearing last week on the topic. "The first thing we
need to do is get more information about what benefits are being provided and
what are the differences between insurers."
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