Individual plan changes depend upon drug regimens

Medicare’s annual open enrollment period, during which individuals can either enroll in Medicare or make changes to their current Medicare coverage, began earlier this year — on Oct. 15 — and will end earlier, on Dec. 7, rather than on Dec. 31 as in previous years it ended.

This is the time when people with Medicare are advised to carefully review their Medicare heath and prescription drug plans, since insurers change plan details annually. Drug coverage is the key element Medicare enrollees should carefully examine. “The list of drugs included will determine which plan best suits a subscriber,” said Bill Robinson of Palm Canyon Insurance Agency. “A person must run that report [listing all the drugs they take] each year because of changes in what is covered.”

Robinson advised that major changes, both in whether a drug is included in the covered formularies as well as pricing of those drugs, occur each year. If a subscriber simply renews their existing plan without running the drug report on the Medicare website, they could face startling price escalations, sometimes in the thousands of dollars. The Medicare site for running the drug report (the “Formulary Finder” tool on the website) to find the right plan is That site also offers, for the first time this year, a five-star rating system so consumers can more easily identify top-quality plans, based on certain standards of drug inclusion, premiums, deductibles, ability to go to doctors of choice or only those in the plan network, offered services and overall estimated annual health and drug costs. Warnings are also included for plans that are consistently poor performers. General Medicare information with links to more specific content is available at The independent Consumer Reports also offers a free guide explaining how Medicare works, how to sign up, and specific changes for this year at

Changes for 2012 of particular interest to consumers are free preventive services such as checkups, mammograms and flu shots, and discounts on brand-name and generic prescription drugs in the Medicare coverage gap, as well as higher premiums for those with higher income. Preventive services covered at 100 percent include an annual wellness visit (not a physical exam), prostate cancer screening, colon cancer screening, mammograms, diabetes screening, pap smears and pelvic exams, blood tests for heart disease, flu shots, pneumonia vaccine, hepatitis B vaccine, and glaucoma screening.

Because of the Affordable Care Act, people who enter the drug prescription coverage gap in their Part D drug plan will get a 50-percent discount on brand-name drugs. Continuing though 2020, the coverage gap cost to subscribers will gradually decrease. Starting in 2011, beneficiaries will pay a smaller percentage for brand-name drugs in the gap, starting at 50 percent and gradually reducing to 25 percent; for generics it begins at 93 percent and gradually reduces to 25 percent.

Other changes for 2012 include a new “Independence at Home Demonstration Program” designed to introduce to chronically ill Medicare beneficiaries payment incentive home-based primary care teams of physicians and nurse practitioners to help reduce expenditures and improve health outcomes to keep patients in their homes, thereby reducing hospitalization time; a “Physician Compare” website that provides comparable information on physician performance including quality and patient experience, patient outcomes, care coordination, safety, effectiveness and timeliness of care, and other information.

In other good news for beneficiaries, overall premiums for Part D prescription plans are decreasing as a result of the Affordable Health Care Act. There is a caveat — some drug companies, in anticipation of the 50 percent reduction requirement, raised prices of covered drugs by as much as 40 percent.

In a twist worth watching, this year, for the first time in three years, there will be a cost-of-living raise for Social Security recipients of a few percent, but because of how Medicare premiums are tied to a version of the U.S. Consumer Price index, that increase may be eaten up by a consequent rise in premium costs.

A workshop explaining Medicare plans will be given by Amante & Associates Insurance Solutions, Inc. at 10 a.m. Monday, Oct. 24 and Monday, Nov. 14 at Idyllwild Town Hall.