Medicare Open Enrollment: What You Need to Know This Year

The Lake Oconee Boomers Team

Updated on:

IMG00967By Karen Peebles, Community Outreach Manager, Care Improvement Plus

Medicare’s fall open enrollment period is undergoing some adjustments this year, and South Carolina Medicare beneficiaries need to be aware of how it will impact their ability to change their Medicare coverage.

Most importantly, open enrollment begins and ends early this year, starting on Oct. 15, 2011 and lasting only until Dec. 7, 2011. In past years, Medicare-eligible individuals had until December 31st to evaluate Medicare options and make decisions regarding their coverage.

In addition, this year’s open enrollment period sees another step toward closing the prescription drug coverage gap or “donut hole”. Beneficiaries reaching the coverage gap in 2012 will receivea50 percent discount on approved brand name formulary drugs and a 14 percent discount on generic drugs.

It’s crucial to use this year’s open enrollment period to review and discuss the many options available to you with your loved ones. Below are five helpful tips that all Medicare beneficiaries should consider:

  • Evaluate your health needs: If you have a chronic condition such as diabetes or receive assistance from Medicaid, there are health plans called “Special Needs Plans” that cater to your specific needs. These plans are required to offer benefits and care assistance programs to help support your health
  • Compare additional services provided by plans: Free transportation to medical appointments, nurse hotlines, pharmacist counseling, and house call visits can help save you money and keep you out of the hospital – valuable items to consider for any plan
  • Involve a trusted family member or friend: Don’t feel like you have to do this alone—involve your daughter, son, or other family member to help with your Medicare coverage decision
  • Check into plan “rules”:Some plans may require you to see specific doctors and obtain advance approvals prior to seeking care.  Other plans allow you the freedom to select your physicians and receive treatment without interference
  • Research your options: While a zero-dollar premium option may sound appealing, make sure to estimate the out of pocket costs associated with benefits and services you normally use

Keep in mind that once open enrollment ends, you may still be able to make changes to your Medicare coverage. Many don’t know that Medicare offers “Special Election Periods”providing the opportunity to change Medicare coverage anytime of the year.  For example, eligible beneficiaries with diabetes or heart failure are allowed a one-time special election period to enroll in a Special Needs Plan for their condition. In addition, eligible Medicare beneficiaries receiving full Medicaid assistance may switch their coverage at any time of the year.

Medicare open enrollment may seem overwhelming to seniors and their loved ones, but, it doesn’t have to be that way. Arming yourself with knowledge and tapping into available resources can help simplify the process and ensure that you select the best option to fit your health needs.

Care Improvement Plus provides specialized Medicare coverage for underserved and chronically ill beneficiaries [in select counties] throughout [State]. To learn more, call 1-866-727-6646 or visit