Medicare changes in 2014 - What you need to know

Wednesday, August 14, 2013

If you are enrolled in a Medicare Advantage (MA) plan, you may be wondering how the Affordable Care Act and other Medicare changes will affect your coverage in the coming years.

In the past, private insurance companies running MA plans were paid about $1,100 more per person than what was paid for people in original Medicare. Since 2012, the Affordable Care Act has been bringing those payments down to be more comparable to rates under original Medicare. As a result, some MA plans have chosen to increase premiums, reduce extra benefits, or even leave the Medicare program. However, they are not allowed to cut any benefits provided under original Medicare.

As Medicare Advantage plans make changes to their premiums, benefits and provider networks, it is important for seniors enrolled in these plans to review their needs and health coverage each year. Choosing the right MA plan is important. According to a 2012 PlanPrescriber study, nine out of 10 individuals selected the wrong plan and could have saved an average of $650 each year if they were on the right plan.

We’ve asked our partners at MB Senior Solutions to help us address a few of the most common questions about MA plans and what seniors need to know heading into 2014.

Council on Aging partners with MB Senior Solutions to help area seniors make important decisions about their Medicare and prescription drug coverage. Through this partnership, Medicare eligible older adults can access free services including a review and analysis of individual health plan and prescription needs, and help with plan enrollment and annual renewals. You can access these free services by contacting Council on Aging at (513) 721-1025.

COA also offers onsite appointments with a volunteer from the Ohio Senior Health Insurance Information Program (OSHIIP).  The trained volunteer is available to: help seniors make decisions about Medicare coverage; facilitate appeals for denied coverage; and act as a mediator between patients and providers when coverage problems arise.

How is Medicare affected by Health Care Reform?
Health Care Reform will affect the Medicare program in many ways—some of the changes are positive, and some changes will require enrollees to be more engaged and informed in their Medicare planning.

Changes include:

  • Medicare now covers certain preventive services, like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible. You also can get a free yearly "Wellness" visit.
  • A phase out of the prescription drug “donut hole.” By 2020, you'll pay only 25% for covered brand-name and generic drugs during the gap. Click here for more information about the donut hole phase out.
  • Better care coordination.  With new initiatives to support care coordination, your doctor may get additional resources to make sure that your treatments are consistent.
  • Reductions in overpayments to Medicare Advantage plans could result in changes to plan benefits, premiums and provider networks. 

What does this mean for seniors in 2014?
Beginning this fall and every year going forward, seniors enrolled in Medicare Advantage plans should be prepared to review their coverage and make changes that could potentially enhance their coverage and save them money. Not only do the plans change each year, but so do seniors’ health needs.  It is important for seniors to explore alternate plan options to ensure all of their important doctors are in-network, their prescriptions are covered, and that they have access to health care wherever they travel. 

When should seniors review their coverage?
Mid-to-late September, seniors enrolled in Medicare Advantage plans will receive a Annual Notice of Change letter from their insurance company, outlining changes to their plan for the coming year.  Medicare’s open enrollment period runs Oct. 15 – Dec. 7.  During this time, seniors can: switch from traditional Medicare to a Medicare Advantage plan; switch from a Medicare Advantage plan back to traditional Medicare; or switch from one Medicare Advantage plan to another. 

Where can seniors turn for help in reviewing their coverage and choosing a plan?
Medicare’s website,, offers a Medicare Plan Finder to help seniors find and compare plans available in their area. The site also offers a step-by-step guide to using the plan finder.

If you are new to Medicare, the Ohio Senior Health Insurance Information Program will host two free Welcome to Medicare webinars this fall - Sept. 16 and Dec. 16. These webinars are free and open to the public, but you must register in advance. Click here for information.

Seniors who need assistance reviewing coverage options or enrolling in plans can contact Council on Aging at (513) 721-1025.