Medicare Watch

Your Weekly Medicare Consumer Advocacy Update

Medicare Fall Open Enrollment Begins

October 17, 2013

People with Medicare Should Review Their Health and Drug Coverage Options Carefully

Medicare’s Fall Open Enrollment Period is October 15 through December 7, and the Medicare Rights Center urges everyone with Medicare who is enrolled in a private health or drug plan to use the Fall Open Enrollment Period to review their choices. Because plans make changes to their benefit packages every year, even people who are currently happy with their plan should review their coverage. Those enrolled in Original Medicare can also decide at this time to switch to a private plan, or choose a new stand-alone drug plan.

During the Fall Open Enrollment Period, Medicare beneficiaries have the right to make as many changes as they need, and the last change they make on or before December 7 will go into effect on January 1, 2014. “Medicare beneficiaries need to be aware of any changes to their current plan and carefully review all of their options in time to make a decision by December 7,” said Joe Baker, President of the Medicare Rights Center. “While reviewing your options, it is important that you contact the plan to confirm any information you find. Once you have made your decision, you can enroll in the plan by calling 1-800-MEDICARE.”

The Medicare Rights Center urges people to consider the following questions before enrolling in a Medicare Advantage or stand-alone prescription drug plan:

  • Will I be able to use my doctors? Are they in the plan’s network and are they taking new patients who have this plan?
  • Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network?
  • Who can I choose as my Primary Care Physician (PCP)?
  • How much is my monthly premium?
  • Do I need a referral to see a specialist?
  • Are my prescription drugs on the plan’s formulary (list of covered drugs)?
  • Does the plan require that I get “prior authorization” before my prescription will be covered, or impose other restrictions (like limiting the quantity or requiring that I try a cheaper medication before it will cover a more expensive one)?
  • How much will I have to pay out of pocket before coverage starts (what is the deductible)?
  • How much will I pay for brand-name drugs? How much for generic drugs?
  • What service area does the plan cover?
  • What kind of coverage do I have if I travel outside of the service area?

Use the Medicare Plan Finder tool at or call 800-MEDICARE to review your options and get details. Medicare Rights recommends that beneficiaries call the plan to confirm the information they find, and keep a record of the conversation with the plan representative. Medicare Rights also recommends enrolling in a plan by calling 800-MEDICARE rather than the plan itself.

For a list that includes these and more questions to ask, visit Medicare Interactive.

Beneficiaries who prefer to speak with a counselor can call the Medicare Rights Center’s toll-free helpline at 800-333-4114. Counselors are available Monday through Friday.

State Health Insurance Assistance Programs (SHIPs) also provide free counseling services. To find your local SHIP, go to or call 800-677-1116.

Report Shows That Few People Switch Part D Plans, Despite Potentially Lower Costs

Relatively few people on Medicare use the Fall Open Enrollment Period to switch Part D prescription drug plans (PDP), according to a recent issue brief published by the Kaiser Family Foundation (KFF). Using information between 2006 and 2010, KFF found that 87 percent of people enrolled in Part D did not switch plans, even though people who did switch were often able to reduce their out-of-pocket drug costs.

According to the KFF issue brief, of the Medicare beneficiaries who switched prescription drug plans at some point between 2006 and 2010, nearly half (46 percent) saw their premiums fall by at least five percent the following year. In contrast, only eight percent of beneficiaries who did not switch plans saw their premiums fall by at least five percent. Additionally, most beneficiaries who did not switch plans between 2006 and 2010 faced large premium increases (of at least $10 per month) from one year to the next.

The KFF analysis shows that many Medicare beneficiaries could lower their Part D premiums by comparing their plan options during the Fall Open Enrollment Period. Although the reasons why more beneficiaries don’t switch PDPs is unclear, qualitative evidence from various polls and focus groups supports the notion that that the current Part D landscape is too complicated and offers too many choices. According to KFF, policymakers may want to consider ways to simplify beneficiaries’ decision-making, including providing better tools to support beneficiaries during the decision-making process.

Read the KFF issue brief.

Volume 4, Issue 40

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Medicare Reminder

If your Medicare Advantage plan is ending on December 31, 2013 and you do not qualify for any assistance programs that may entitle you to a Special Enrollment Period, you need to make decisions about your Medicare coverage before the end of the year. If your plan will not be available in 2014, your plan should send you a notice informing you of this change by October 2, 2013. This notice may also include a list of other Medicare Advantage plans in your area. Remember, you can get your Medicare benefits either through Original Medicare, the traditional Medicare program administered directly through the federal government, or a Medicare Advantage plan, also known as a Medicare private health plan.

If you want to join another Medicare Advantage plan, you can sign up for a new plan at any time between October 15, 2013 and February 28, 2014. You can learn about the different plans offered in your area by going online and visiting or by calling 800-MEDICARE. Keep in mind that it’s best to sign up for a new plan by December 31, 2013, so you can get plan coverage beginning January 1 of the following year. If you wait until January or February to enroll, your coverage will start the first of the month after you enroll. You will have Original Medicare with no drug coverage until your Medicare Advantage plan coverage starts.

Keep in mind that if you decide to have Original Medicare in 2014, you will most likely need to sign up for a Medicare Part D plan, and you may want to consider a Medicare supplement, also known as a Medigap. While you have until February 28, 2014 to sign up for a Part D plan, you should sign up before December 31, 2013 so that you can get drug coverage beginning January 1, 2014. If you wait until January or February to enroll into a Part D plan, your coverage may not begin until the first of the month following the month of enrollment.

Learn more about Medicare Special Enrollment Periods at




On October 15, the first day of Medicare Fall Open Enrollment, the Medicare Rights Center held a live Q&A session with the Center for Medicare Advocacy moderated by The session answered common questions from people who are considering their Medicare coverage options, including:

  • What changes can I make during Fall Open Enrollment?
  • What is the difference between Original Medicare and a Medicare Advantage Plan?
  • When does my new coverage start?
  • Can I sign up for a Medicare supplemental coverage, also known as a Medigap?

For answers to your questions, please visit or call our national helpline at 1-800-333-4114.

Watch the Q&A.


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