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May 27, 2013

2012 Medicare Changes in Texas

Did you know the United States government revises the Medicare program every year? This year 2012 Medicare changes are applicable to all members and may affect your current plan. This article will give you an overview of some of the most important 2012 Medicare changes.

Don't Miss the New Annual Enrollment Period!

One of the most important 2012 Medicare changes to know about is the new Annual Enrolment Period which begins October 15, 2011 and ends on December 7, 2011 (instead of the previous November 15 to December 31). The Annual Enrollment Period is your opportunity to compare, enroll in, or switch Medicare Advantage and Medicare Prescription Drug Plans, all with an effective date of January 1, 2012.

Additional 2012 Medicare Changes

Many 2012 Medicare changes affect details that may influence your selection of plans:

  1. "Medicare and You" handbooks will be sent by mail on September 15, 2011 (instead of the customary October 15) to all Medicare beneficiaries.

  2. You may also receive an Annual Notice of Change on September 30, 2011, which is earlier than previous years.

  3. There is a new Special Enrollment Period (SEP) for Medicare Advantage and Prescription Drug Plans with an overall 5 star rating. As provided in 2012 Medicare changes, this Special Election Period includes the following stipulations:

    • The 2012 Medicare changes define the new election period as valid only for Medicare Advantage plans and Prescription Drug Plans with general plan summary ratings of 5 stars. The election period cannot be utilized to enroll in other types of plan. Moreover, the enrollment period doesn't provide any additional right to choose other coverage outside the normal enrollment period as specified in the 2012 Medicare changes.
    • 2012 Medicare changes define that the annual SEP will begin December 8, 2011. When you enroll via this SEP your enrollment application will take place on the first of the month following to the month the enrollment application was received.
    • Your SEP will stop for the plan year once you enroll in a 5-Star MA plan or PDP using this SEP and you will only be allowed to make alterations during other applicable election periods as provided in the 2012 Medicare changes.
    • Only plans which get an overall 5 star rating will be required to accept these SEP requests, unless CMS closes the plan due to over capacity limit.
    • You cannot use the SEP for enrollment in a plan which doesn't have a total, overall summary 5 star rating, even if the plan obtains 5 stars in some sub-categories or if it is in the same parent organization of other plans receiving overall 5 star ratings.
    • According to the 2012 Medicare changes, if you are currently enrolled in a Medicare Advantage plan with Prescription Drug coverage (MAPD) and choose to enroll in a 5 star PDP, you'll be dis-enrolled from the MAPD and obtain your health coverage via Original Medicare (Medicare Part A and Medicare Part B) and the new PDP.

Additional Medicare Part D Plan revisions in the 2012 Medicare changes

2012 Medicare changes to Medicare Part D plans are as follows:

  • Part D Maximum Deductible is raised from $310 (in 2011) to $320.
  • Part D Initial Coverage Limit is moved from $2,840 (in 2011) to $2,930.
  • Part D Maximum out-of-pocket cost is boosted up from $4,550 (in 2011) to $4,700.
  • Part D Coverage Gap or the Medicare Donut Hole (which is the gap between the initial coverage limit and the max out-of-pocket) is $2,930 - $4,700. Same as in 2011, you'll obtain a 50% cut on your covered brand name drugs all through the coverage gap.

Medicare has neither approved nor endorsed this information.