Once-a-year Medicare open enrollment allows switch in Advantage and drug plans

Medicare beneficiaries who want to change their prescription drug plan or Medicare Advantage coverage for 2015 can do so starting Oct. 15, during the Medicare program’s annual open enrollment period. There will be somewhat fewer plans to pick from this year, but in general people will have plenty of options, experts say.

And although premiums aren’t expected to rise markedly overall — in some cases, they may actually decline — some plans have set significantly higher rates. But rather than rely on the sticker price alone, beneficiaries should compare their options to find the plan that covers the drugs and doctors they need, at the best price.

Open enrollment, which ends Dec. 7, is also an opportunity to switch to a private Medicare Advantage plan from the traditional Medicare fee-for-service plan or to move from one Advantage plan to another.

Although the Centers for Medicare & Medicaid Services has released some specifics about 2015 premiums and plans, some details about provider networks and the like won’t be available until open enrollment begins.

Here's what we know so far:

Standalone prescription drug plans

The number of Part D standalone prescription drug plans will drop by 14 percent, to 1,001 plans. This is the smallest number of offerings since theMedicare Part D program began in 2006.

Even so, “seniors across the country will still have a choice of at least two dozen plans in their area,” says Tricia Neuman, director of the Program on Medicare Policy at the Kaiser Family Foundation. (Kaiser Health News, which helps produce this column, is an editorially independent program of the foundation.)

The drug plan consolidations that are driving the reduction in choices will probably prompt many beneficiaries to choose lower-cost plans, resulting in an average premium decline of 2 percent, to $38.95 per month, according to an analysis by Avalere Health, a research and consulting firm.

But that average obscures significant price hikes by some of the biggest plans. The average premium for the WellCare Classic plan, for example, will increase 52 percent, to $31.46, while the Humana Walmart RxPlan premium will rise 24 percent, to $15.67, according to Avalere.

Insurers are expected to continue to shift more costs to beneficiaries next year. The percentage of drug plans with no deductible will decline to 42 percent from 47 percent, and, once again, about three-quarters of plans won’t offer any coverage in the “doughnut hole”— the coverage gap in which beneficiaries are responsible for shouldering a greater share of their drug costs.

Underscoring the importance of evaluating plan options, 70 percent of standalone drug plan members will probably see their premiums increase if they stick with the same plan in 2015, says Ross Blair, senior vice president for eHealthMedicare.com, an online vendor.

Seniors, though, have historically not voluntarily switched plans in great numbers during annual enrollment. Between 2006 and 2010, only 13 percent did so on average, according to a 2013 analysis by researchers at Georgetown University, the Kaiser Family Foundation and the University of Chicago.

Medicare Advantage

Enrollment in Medicare Advantage plans continues to grow: 30 percent of Medicare beneficiaries are now in these private alternatives, which typically are managed-care plans that often provide benefits — such as vision and dental coverage — that traditional Medicare does not. Concerns that the number of Medicare Advantage plans would shrink significantly as the health law reduces federal payments to them have proved unfounded to date. In 2015, the number of plans will drop by 3 percent, to 2,450, continuing a gradual decline.

“You still have lots of plans and robust selection,” says Caroline Pearson, an Avalere vice president. Some parts of the country appear to be harder hit by plan reductions than others, including the Southeast and Mid-Atlantic regions, Pearson says.

Health maintenance organizations have always been the dominant sponsors of Medicare Advantage plans, and this trend will continue in 2015. The number of HMOs will increase by 1.5 percent, to 1,747, while the number of preferred provider organizations will drop by nearly 9 percent, to 541, according to Avalere. About two-thirds of Medicare Advantage beneficiaries are now in HMOs, while 31 percent are in PPOs.

The average premium will increase by $2.94 to $33.90, but nearly two-thirds of beneficiaries won’t see any increase, according to CMS. Like standalone drug plans, however, fewer Medicare Advantage drug plans will offer no deductibles and gap coverage, according to Avalere.

“It’s one example of how plans are tightening up coverage” and pushing more costs onto consumers, Pearson says.

Source: This column is produced through a collaboration between The Post andKaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.