2015 Medicare Open Enrollment Period
For 2015, the Centers for Medicare and Medicaid Services (CMS) have designated Oct. 15th through Dec. 7th as the open enrollment period for Medicare Parts C and D coverage. Part C covers the individual’s Medicare health maintenance organization or Medicare Advantage enrollment as a voluntary alternative to traditional fee-for-service (i.e., Parts A and B). Part D provides Prescription Drug Plan (PDP) coverage. For individuals enrolled in Medicare Advantage, the prescription drug coverage is generally rolled into the Part C benefit.
For care and service providers, it is important to be aware of the open enrollment period and the full array of CMS resources to assist and guide the individuals you serve, especially when it comes to ensuring they are in the proper PDP. Two critical factors guiding an individual’s PDP decision are: 1.) Ensuring that the PDP formulary covers the necessary drugs; and 2.) Ensuring the PDP offers a Low Income Subsidy (LIS) for individuals who should not have any cost sharing. For example, dual eligibles in the nursing home should be enrolled in a LIS plan with no cost sharing.
Every year at this time, CMS encourages beneficiaries to review their options as Medicare Advantage and PDP coverages in individual plans may change from year-to-year. Key to determining the possible need to change plans are the materials sent out by the plans to enrollees advising of coverage changes, including any “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC) mailings.
Beneficiaries can find Medicare plan information and compare options by calling 1-800-MEDICARE or going to the Medicare.gov website. The website contains a variety tools as part of the CMS outreach and media materials for open enrollment. There is also the CMS 2015 Medicare Open Enrollment Toolkit.
Often the most challenging decision for seniors is choosing the best PDP. The CMS website provides specific Prescription Drug Plan Resources. Perhaps the most helpful tool in this regard is the Formulary Finder.
The following tools are also available under the 2016 Plan and Premium Information for Medicare Plans Offering Part D Coverage:
- Compare Medicare Prescription Drug Plans - Medicare Prescription Drug Plan Finder
- Enroll in a Medicare Prescription Drug Plan - Medicare Prescription Drug Plan Finder
CMS also provides a state-by-state analysis of the upcoming year in Medicare. For New York, CMS projects the following:
Medicare in New York, 2016
Medicare continues to grow, while offering seniors and people with disabilities stable premiums and improved quality of care. Whether through Original Medicare (Parts A and B), Medicare Advantage, or the prescription drug benefit (Part D), 3,329,495 beneficiaries in New York continue to have access to improved benefits thanks to the Affordable Care Act, including:
Certain preventive benefits – including certain cancer screenings – are available at no cost to beneficiaries when provided by qualified and participating health professionals. The annual wellness visit provides beneficiaries with the opportunity to sit down with their doctor to discuss their health care needs and the best ways to stay healthy.
In 2016, if beneficiaries reach the coverage gap known as the “donut hole” in Medicare’s prescription drug benefit, they’ll save 55 percent on covered brand name drugs and see increased savings on generic drugs.
In New York in 2016:
- 100 percent of people with Medicare have access to a Medicare Advantage plan • 229 Medicare Advantage plans available
- 22 Medicare Prescription Drug Plans available
- 91 percent of people with Part D have access to a plan with a lower premium than what they paid in 2015
- 36 percent of people with Medicare Part D get Extra Help (also called the low-income subsidy, or LIS)
- $18.40 is the lowest monthly premium for a prescription drug plan in 2015, 1,036,052 people in New York with Original Medicare took advantage of at least one preventive service without cost-sharing through July 2015.
Since the passage of the Affordable Care Act, people with Medicare in New York have saved $1,366,778,919 on prescription drugs through July 2015 as a result of the discounts in the donut hole and rebates in 2010.
2016 Medicare Open Enrollment Important Dates
The Medicare Annual Election Period runs from October 15, 2015 to December 7, 2015. All Medicare beneficiaries should take the opportunity to review their health care needs for the upcoming year and determine if changes to their current coverage is necessary. Plan costs and coverage change each year, so everyone with Medicare should check to make sure their plan still meets their health needs and budget. By shopping available plans and comparing costs, beneficiaries may be able to find a Medicare health or drug plan with better coverage or a lower premium in 2016.
September 2015
· The “2016 Medicare & You” handbooks are mailed to Medicare beneficiaries.
· Health and drug plans begin notifying enrollees about changes to their plans in 2016.
October 2015
· Beneficiaries can begin shopping and comparing plans on Medicare.gov starting October 1.
· Beneficiaries should watch their mail for notices from Medicare with information about changes in 2016.
· Medicare health and drug plan Star Ratings will be available on Medicare.gov starting October 8.
· Medicare Open Enrollment begins October 15.
December 2015
· Medicare Open Enrollment ends December 7. January 2016
· Medicare plan coverage begins January 1.
January 2016
· Medicare plan coverage begins January 1.
Source: CMS website.
Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827