Things you need to know about Medicare for 2012


                                          By Arthur Carson       State Licensed in FL, MO, and MI

Healthcare Reform”, formally known as the Patient Protection and Affordable Care Act (PPACA) has effected some very important changes for “Plan Year 2012” (PY2012). Here are a few:

First of all, the Annual Enrollment Period (AEP) dates have been changed from Nov 15th through the end of the year, to Oct. 15th through Dec. 7th. Plan providers, (for example Humana or United Healthcare) will be allowed to present new plan specifics and materials beginning Oct. 1st. However, no enrollment applications can be accepted until Oct. 15th.
During this period, current Medicare beneficiaries may choose how they receive their Medicare benefits for the upcoming year. No action is needed if you wish to keep your current plan. You may enroll, disenroll or change plans. The last election made, determined by the application date, will be the election that takes effect on Jan. 1st for the calendar year. Be careful in choosing. Check your current plan for any changes. Consider your maintenance drugs, as each plan with an integrated prescription drug plan has its own formulary.
Basically, unless you are covered under a current or former employer’s group plan, these are your choices:
1.     Original Medicare only – this is having Medicare Parts A and B
2.     Original Medicare with a Medicare Supplement or “Medigap” policy
3.     Original Medicare with a “stand alone” Part D Prescription Drug Plan
4.     Original Medicare with both Supplement AND a Part D Prescription Drug Plan
 (By law, Medicare Supplement plans cannot provide prescription drug benefits.)
5.     Enrolling in a Medicare Advantage Plan (most offer an integrated Part D drug Plan)
Secondly, if you elected to enroll in an MA or MAPD plan, you will have 45 days between Jan 1st and Feb 14th, 2012, during the Medicare Advantage Disenrollment Period (MADP) in which you may request disenrollment from their plan and return to Original Medicare and subsequently may enroll in a PDP or may simply request enrollment in a PDP, resulting in automatic disenrollment from the MA plan. The exception being that MA-only PFFS must first request disenrollment. As allowed in past years, you MAY NOT change MA plans during this period.
Types of Medicare Advantage (MA) plans include HMOs, PPOs, RPPOs, PFFS, Medicare Savings Account, Cost Plans and Special Needs Plans (SNPs) for those diagnosed with specific qualifying chronic diseases such as diabetes or COPD (for example.) Enrolling in a Supplement or any Medicare Advantage plan does NOT disenroll you from original Medicare. As long as you maintain Parts A and B, you are always a “beneficiary” of Medicare. “No plan premium” simply means that the government pays the provider. You still must pay your Part B monthly premium ($115.40 in 2011) which is commonly deducted from your Social Security check.
I’m happy to answer any questions you may have or meet with you to discuss your personal situation regarding Medicare, Medicaid, turning 65 or health insurance in general. There is no obligation.
Please email your questions to me at with your contact information. Please include your mailing address so I may add you to my free “Health Reform Updates” newsletter. If you prefer, please leave a message at (305) 677-7031 and I’ll call you back. – Art Carson