Medicare benefits slated to change

Big changes are coming to Medicare benefits received through some private plans, so experts urge participants not to wait for enrollment season this fall to learn what they'll need to do.

The changes affect private insurers that provide coverage to Medicare enrollees under programs known as Medicare Advantage plans, which can sometimes offer a larger array of benefits for certain enrollees.

Frustrated by higher costs associated with the alternative program, the Obama administration recently put providers on notice that reimbursements could fall and plans with low enrollment could be scrapped next year as the nation deals with financial issues in Medicare and Social Security.

If you're one of the more than 10 million seniors enrolled in the plans -- or you are considering enrolling -- here's what you need to do before open enrollment begins Nov. 15:


* Review your plan

The current patchwork of plans has such a confusing array of benefits that some enrollees may not fully understand their plan well enough to make a comparison if they'll need to find a new one, said Paul Precht, policy director for the Medicare Rights Center, a New York-based advocacy organization.

Review your plan to see if it carries an out-of-pocket maximum, for example, because some don't cap expenses, Precht said.

"Some consumers are lured in to these plans with low premiums" and they don't realize the ones designed for supplemental coverage might not have an out-of-pocket cap, he said.


* Don't assume a plan closing is a negative

"There is absolutely a perception that Medicare Advantage plans have richer benefits," but that's not always the case, said Judith Stein, executive director of the Center for Medicare Advocacy Inc. in Mansfield Center, Conn.

The center recently released an issue brief outlining the Centers for Medicare and Medicaid Services' 2010 Call Letter, which sets guidelines for private insurers' bids to provide Advantage plans.

The brief covers implications of the guidelines for beneficiaries and concludes that they will bring more accountability to Advantage plans.


* Watch the departures

Although the government announced it may close plans, those are mostly rural plans that have relatively few participants, said Peter Ashkenaz, a Centers for Medicare and Medicaid Services spokesman.

A bigger effect may come if private insurers walk away. Coventry Health Care Inc. of Bethesda, Md., and WellCare Health Plans Inc. of Tampa have said they wouldn't renew their private fee-for-service plans under Medicare next year. Those two companies served about 400,000 enrollees in those plans.


* Track the debate

As enrollment season moves closer, pay close attention to ads and direct-mail pieces regarding any changes.

Although some groups, such as the Medicare Rights Center, support the changes because the group opposes private insurers receiving high reimbursements relative to the regular Medicare program, some industry groups are painting the issue as a hit to seniors.

"It is vital that seniors continue to have access to the benefits and services they rely on," said Karen Ignagni, president of America's Health Insurance Plans, an industry group in Washington, D.C.


Stewart writes for the Chicago Tribune.

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