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What To Know About Medicare’s Enrollment Period


Though not a part of the health law’s open enrollment period, Medicare’s enrollment period runs during some of the same time period. Changes to Medicare advantage and the so-called Medicare prescription drug “doughnut hole” are taking center stage. KHN’s Mary Agnes Carey and Julie Rovner discuss:

MARY AGNES CAREY: Welcome to Enrollment Encore. What you need to know before open enrollment and the health law’s marketplaces begins again on November 15. I’m Mary Agnes Carey. Kaiser Health News senior correspondent Julie Rovner now joins me to talk about the health law and Medicare. Julie, what are the key issues for Medicare beneficiaries when it comes to the Affordable Care Act?

JULIE ROVNER: Well, there are not really very many issues from the ACA that directly affect people on Medicare. In fact, people on Medicare are not allowed to be in the exchanges. It’s just sort of a coincidence that the Medicare open enrollment period is going to coincide at least partly with the ACA open enrollment period. Medicare open enrollment started in the middle of October and ends December 7.

MARY AGNES CAREY: And we’ve heard a lot about changes in payments to these private health insurance plans and Medicare and now there’s Medicare Advantage. What has been the impact of those changes in the number of plans offered and also for beneficiaries?

JULIE ROVNER: That’s right. One of the ways the Affordable Care Act is paid for is by cutting some of the payments to the Medicare Advantage plans because they were being overpaid by about 14 percent. Now the last time Congress tried to cut payments to Medicare Advantage plans in the late 1990s, a lot of the plans left the market, a lot of seniors were left without any options. That’s not been the case this time. The cuts are being phased in more slowly. There are slightly fewer plans, but not that many fewer, and actually enrollment is way up in Medicare Advantage plans. It’s up 41 percent since the ACA passed in 2010.

MARY AGNES CAREY: There is also some changes in what they call the donut hole, this gap in coverage. That’s shrinking and also some higher income beneficiaries and may pay more for their coverage. Can you tell me about that?

JULIE ROVNER: That’s rights. Some of the smaller changes the ACA made to Medicare: There are new preventative benefits for seniors. As you mentioned, the donut hole, which was a big issue, this is when seniors are still paying for their Medicare Part D coverage, their prescription drug coverage, and not getting any benefit from it. That’s no longer the case. That donut hole is slowly being closed. By 2020 it will be basically all the way gone. And of course, for higher income Medicare beneficiaries, those who make more than $85,000 as a single or couples that make more than $170,000, they do pay a couple of additional taxes. Really, they are supplemental premiums they were already paying for Part B and now they’re going to pay them for Part D, for their prescription drug coverage as well.

MARY AGNES CAREY: Thank you Julie Rovner with Kaiser Health News.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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