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Medicare Advantage costs to be lower next year, say feds

WASHINGTON, Sept. 21 —

The Centers for Medicare & Medicaid Services (CMS) announced today that, on average, Medicare Advantage premiums will be 1 percent lower in 2011. The majority of Medicare beneficiaries, on average, enrolled in Medicare health and prescription drug plans this year should find little or no change in their benefits in 2011, in addition to seeing more drug plans offering coverage in the prescription drug coverage gap or “donut hole.” Medicare Advantage plans project that enrollment will increase by 5 percent in 2011. And, consistent with the Affordable Care Act, beneficiaries, in most Medicare Advantage plans and Original Medicare, will gain access to preventive benefits with no out of pocket costs.

“The Affordable Care Act gave us new authority to negotiate with health plans in a competitive marketplace. As a result, our beneficiaries will save money and maintain their benefits,” said CMS Administrator Dr. Donald Berwick.

“Even with the lower costs, all beneficiaries should take time this Fall to compare their current health and drug plan coverage with what’s available and best meets their needs for next year,” said Jonathan Blum, deputy administrator and director of CMS’ Center for Medicare. “Medicare will continue to provide a wide-range of consumer tools to help beneficiaries make the best possible choice of coverage.”

As expected and, similar to the past five years, about 5 percent of non-employer beneficiaries enrolled in Medicare Advantage and stand-alone Prescription Drug Plans will need to choose a new health plan or Original Medicare in 2010 because their current plan is not renewing its contract with Medicare in 2011. Most of these ‘non-renewals’ occur because private fee-for-service (PFFS) plans made business decisions to leave Medicare in certain areas of the country, largely due to a 2008 law that ensures protections for beneficiaries enrolled in PFFS plans in certain areas of the country.

All but 2,300 enrollees in Medicare Advantage plans that no longer participate in Medicare will have a choice of enrolling in a different plan. In 2010, 86 percent of beneficiaries whose plan no longer participated in Medicare joined a new Medicare Advantage plan.

CMS will continue to work with beneficiary advocates and State Health Insurance Assistance Programs (SHIPs) and send letters to beneficiaries to make sure they take the necessary steps to keep coverage that best meets their needs next year. Beneficiaries enrolled in plans that are not available next year recently began receiving notice of the non-renewal from their plan.

Beneficiaries who do not enroll in another health plan will receive medical coverage under Original Medicare, but must enroll in a Part D plan to keep their drug coverage.

Beneficiaries eligible for the Part D low-income subsidy will be enrolled in a zero-premium drug plan if they do not select a plan.

The Affordable Care Act also provides some new benefits to Medicare beneficiaries in 2011 like free wellness visits, some new free health screenings, and a 50 percent discount on brand-name drugs for seniors who full into the coverage gap. Beneficiaries should look for information about these benefits in their open enrollment materials.

CMS is encouraging beneficiaries enrolled in Medicare Advantage and Medicare Prescription Drug plans to review their current health and drug plan coverage for any changes their plans may be making for 2010 before the annual enrollment period begins Nov. 15.

In addition to the 5-Star ratings on the Medicare Plan Finder at, users will find an icon that shows those plans that had a low overall quality rating the past three years.

Beneficiaries should receive their 2011 Medicare & You handbook and find updated information at and 800-Medicare in mid-October. Users of the Medicare Plan Finder, available at, will be able to compare plans’ quality summary rating from the previous year, identify which drugs may or may not be on a plan’s formulary or be restricted, and compare the cost ranges for plans available in their community.

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