Medicare's open enrollment period begins next week, meaning seniors who use the federally funded health insurance program should be reviewing their current benefit packages and determining what changes, if any, need to be made for 2013.
The open enrollment period -- the time during which current subscribers can make changes to their benefits -- runs from Oct. 15 through Dec. 7.
Subscribers, generally those 65 and older, can use the open enrollment period to select a new prescription drug plan or Medicare Advantage plan for 2013, or to switch to the "original" Medicare from their Advantage plan.
It's also a period when seniors can review or consider buying "Medigap" supplemental plans, which are policies sold by private insurers that are meant to pay some of the copays and cover procedures not handled by typical Medicare plans.
Changes to the program set to take effect in 2013 include:
• Medicare will begin covering counseling and screenings for depression, alcohol abuse, cardiovascular disease and obesity.
• Medicare Part D prescription drug benefit subscribers who reach the so-called doughnut hole coverage gap will begin receiving a larger discount while in the doughnut hole -- 52.5 percent on brand-name prescription drugs and a 21 percent discount on generics. In 2012, the discount rate has been 50 percent for brand names and 14 percent for generics.
• In 2013, users can also expect to see redesigned "summary notice," which explains the doctor's bill, how much of that Medicare paid, and what patients must pay.
The Centers for Medicare & Medicaid Services, known as CMS, reported last month that average monthly premiums for Medicare Advantage plans will rise by $1.47 in 2013, to $32.59 a month.
Nationally, while the premiums will go up slightly, CMS also estimates that with altered co-pays and new covered services factored into the equation, actual beneficiary spending will go down in 2013.
About 1.5 million people are expected to sign on with an Advantage plan next year, meaning 14.5 million people -- or about 30 percent of all Medicare beneficiaries -- will be buying Medicare plans through private insurers.
Medicare Part D prescription plan premiums are also expected to remain stable in 2013, at about $30 a month.
Locally, most of the Advantage plan premium prices are increasing by at least 10 percent, said William McKendree, lead counselor with the Allegheny County Apprise Program, a Medicare-funded program operated by Family Services of Western Pennsylvania in partnership with the Allegheny County Area Agency on Aging. The program provides free health insurance counseling for Medicare recipients.
Deductibles, copayments and "out-of-pocket maximums" are also creeping upward, he said.
UnitedHealthcare's Advantage plans, he said, are a notable exception, with premiums holding relatively steady on most of its Part C plans.
One trend noticed by Mr. McKendree's team is that there are higher copays for "high-ticket" therapies such as inpatient imaging and outpatient infusion drugs like chemotherapy, and for outpatient surgical procedures.
As a result, for some therapies, the benefits provided by Advantage plans aren't much better than the "original" Medicare.
"The trend we're seeing [is] less coverage, and more of a copayment on the part of the beneficiaries."
Prices for Part D prescription drugs remained stable across the plans, he said.
Medicare Part D is the six-year-old benefit that covers prescription drugs; it's an optional plan and it carries a monthly premium.
Medicare Part A covers hospitalization and hospice care and Part B cover doctors' services and outpatient care; together these make up the "original" Medicare. Part C -- also known as Medicare Advantage -- offers plans from private insurers that cover Part A and Part B costs, as well as some prescription drug coverage plus vision and dental coverage.
Those with questions about Medicare, especially baby boomers about to enter the program for the first time, can get a copy of "Medicare & You -- 2013" by calling Medicare toll-free at 1-800-633-4227 or by visiting http://pgne.ws/elf0R.
Apprise can be reached at (412) 661-1438.