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What’s New in Medicare

It’s important to stay informed about Medicare updates and changes that may affect your coverage.

Here is a quick summary of recent Medicare updates and changes.

Health exchanges may have little impact on Medicare beneficiaries.

  • Most Medicare beneficiaries are not directly affected by the new Health Insurance Marketplace (also called health exchanges) established by the Affordable Care Act of 2010.
  • You will continue to get your health coverage through Original Medicare or a private Medicare plan.
  • Individuals who are not on Medicare and whose employers do not offer health insurance can shop for and compare plans in the Marketplace.
  • The Marketplace includes the federal and several state-run health exchanges. Your state may have its own exchange or it may participate in the federal exchange.
  • Individuals who buy health insurance in the Marketplace and later become eligible for Medicare need to pay attention to timing when transitioning to Medicare to avoid gaps in coverage and potential enrollment penalties.

Bigger discounts on prescription drugs during the coverage gap

  • The Medicare Part D coverage gap continues to shrink. Your cost-sharing percentage for prescription drugs during the gap is less each year compared to the year before, until the gap closes in 2020.
  • In 2014, you will pay 72% of the total cost for generic drugs or 47.5% of the total cost for brand–name drugs during the coverage gap. You may pay less if your private Medicare plan has additional coverage during the gap.

5-Star Special Enrollment Period

  • If one is available in your area, you can switch to a 5-star Medicare Advantage plan through November 30, 2014.
  • If your current Medicare Advantage plan includes drug coverage and you switch to a 5-Star Medicare Advantage plan that doesn’t, then you won’t be able to get drug coverage until the next Open Enrollment Period. You also may have to pay a penalty.
  • You can only use this Special Enrollment Period one time each year.
  • You can read about Medicare’s Star Ratings at Medicare.gov.