Healthcare Reform Adds Twists to Medicare for Upcoming Annual Enrollment, Allsup Says

Baby boomers aging into Medicare and those considering different coverage for 2011 should start to learn more about upcoming changes

BELLEVILLE, Ill.--(BUSINESS WIRE)-- Healthcare legislation passed earlier this year may make the upcoming Medicare annual enrollment season particularly challenging, according to Allsup, a nationwide provider of Social Security disability representation and Medicare plan selection services.

“Choosing a Medicare plan for the first time or re-evaluating your coverage based on your changing needs can be overwhelming in any year,” said Adrienne Muralidharan, senior Medicare specialist for the Allsup Medicare Advisor®, a Medicare plan selection service for people with disabilities and those over 65. “However, this year there are not only the usual changes, such as higher premiums or plan details, you also need to understand how the Patient Protection and Affordable Care Act may affect your 2011 Medicare coverage.”

The timing is right, Muralidharan added, for the first baby boomers turning 65 early next year to begin educating themselves on their Medicare options before annual enrollment gets under way.

Annual enrollment runs from Nov. 15 to Dec. 31 allowing people to select their Medicare coverage for 2011.

“The annual enrollment period is a narrow window, and people have so much marketing information sent to them during the weeks prior that it can be hard to focus,” Muralidharan said. “Taking time ahead of this to assess your needs and the type of coverage you want will allow you to be better prepared when you evaluate your options.”

Healthcare Reform Provisions Affecting Medicare in 2011

The Patient Protection and Affordable Care Act makes changes across healthcare. These changes include several provisions specific to Medicare:

  • Prescription drug costs should be lower in the donut hole. The new healthcare law seeks to eventually eliminate the current gap in Medicare prescription drug coverage (known as the “donut hole”), when beneficiaries are required to pay for all their medication costs. For 2011, Medicare beneficiaries will receive a 50 percent discount for the cost of brand-name prescription drugs and a 7 percent discount for generic drugs they are taking while in the prescription drug donut hole.
  • Medicare Part B will fully cover preventive care. Medicare Part B is medical insurance that covers things such as physical exams and outpatient treatment. Beginning next year, Medicare beneficiaries will no longer have to pay deductibles or co-pays for preventive services that fall under U.S. Preventive Service Task Force guidelines, such as an annual wellness exam. The new law also waives the Medicare deductible for colorectal cancer screening tests.
  • More beneficiaries may have higher costs for Medicare Part B and Part D coverage. Changes to income-threshold rules and subsidies will affect how much people pay. For Part B coverage, individuals with modified adjusted gross income (income) over $85,000 and married couples with income above $170,000 in 2010 had higher premium costs. Under the former rules, the income threshold was to increase based on the annual inflation rate. However, under healthcare reform rules, the income threshold freezes at the 2010 levels through 2019, meaning more people may have to pay the higher premiums. Beneficiaries above these incomes also are not protected by a “hold harmless” clause, which freezes premiums in years where there is no Social Security cost of living adjustment (COLA), as was the case in 2010 and many expect is likely for 2011.

    In addition, the law reduces the Medicare Part D (prescription drug) premium subsidy for individuals with incomes above $85,000 and couples with incomes above $170,000.
  • Opportunities to change coverage after annual enrollment period will be more limited. Medicare has made significant changes to the open enrollment period, which begins Jan. 1, immediately after annual enrollment closes on Dec. 31. Historically, this “open enrollment” period ran through March 31, during which time people could switch from their existing Medicare plans to similar Medicare coverage, choosing from “like to like” options. However, under the new rules, open enrollment only runs Jan. 1 to Feb. 15 in 2011 and people are limited to disenrolling from their Medicare Advantage plan to enroll in traditional Medicare. Other selections will not be available to consumers.

Additionally, under the new healthcare legislation, changes are being made to Medicare Advantage plans starting in 2011 to enhance quality and ensure they compete more equally with traditional Medicare.

“It’s easy to get confused between Medicare annual enrollment and open enrollment,” Muralidharan said. “However, it’s now more important than ever to look at annual enrollment as your main opportunity to choose your coverage.”

Other Changes to Come

Each year, Medicare premium costs may increase and plan details may change. For Medicare Part B, the premium cost for most people is tied to the Social Security COLA, determined in October for the following year. The Centers for Medicare & Medicaid Services (CMS), which administers Medicare, has said that premiums for Part D plans are expected to increase by about $1 on average to $30 for 2011, and more detail on both Part D and Medicare Advantage plans (Part C) premiums and plans will be available in the coming weeks.

For an evaluation of your Medicare options, please call an Allsup Medicare Advisor specialist at (888) 271-1173 or go to


Allsup is a nationwide provider of Social Security disability, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Founded in 1984, Allsup employs nearly 700 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis. For more information, visit

The information provided is not intended as a substitute for legal or other professional services. Legal or other expert assistance should be sought before making any decision that may affect your situation.


Mary Jung, (773) 429-0940, [email protected]
Rebecca Ray, (800) 854-1418 ext 5065, [email protected]
Dan Allsup, (800) 854-1418 ext 5760, [email protected]

KEYWORDS:   United States  North America  Illinois

INDUSTRY KEYWORDS:   Seniors  Health  Public Policy/Government  Healthcare Reform  Other Health  Other Policy Issues  Public Policy  White House/Federal Government  Professional Services  Insurance  Consumer  General Health



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