Estate and Elder Law

Medicare Update: The Affordable Care Act

The Centers for Medicare and Medicaid Services (CMS) recently announced that Medicare Advantage premiums for 2011 will be, on average 1% lower than in 2010.  Medicare beneficiaries who are enrolled in Medicare health and prescription drug plans should, for the most part, will find little or no change in their benefits in 2011, while more drug plans should be offering coverage in the "donut hole," or prescription drug coverage gap.  The Affordable Care Act should provide most beneficiaries in Medicare Advantage plans or in original Medicare with access to preventive benefits with no out-of pocket costs.

CMS Administrator Donald Berwick, M.D., states that "Medicare Advantage remains a strong and robust option for millions of seniors who choose to enroll or stay in a participating plan today and in the future.  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."  Jonathan Blum, Deputy Administrator and Director of CMS's Center for Medicare, recommends that beneficiaries should review their current health and drug plan coverage and determine what they may need for next year.  He says that "Medicare will continue to provide a wide-range of consumer tools to help beneficiaries make the best possible choice of coverage."  The annual enrollment period for Medicare Advantage and Medicare Prescription Drug Plans begins November 15th.  Beneficiaries should receive their 2011 Medicare & You Handbook and find updated information at and 1-800-Medicare in mid-October.

Almost all Medicare beneficiaries who have access to a Medicare Advantage plan today will continue to have access to a Medicare Advantage plan next year.  Around 5% of non-employer beneficiaries enrolled in Medicare Advantage and stand-alone prescription drug plans will have to choose a new health plan or revert to original Medicare in 2011 because their current plan is not renewing its contract with Medicare in 2011.  This percentage is similar to percentages in the past five years.   Beneficiaries who do not enroll in another health plan will receive coverage under original Medicare, but they will have to enroll in a Part D plan to keep their drug coverage.  All Medicare beneficiaries will continue to have many prescription drug plans available from which to choose.  CMS will continue to send letters to beneficiaries to ensure that they take the steps necessary to have the health coverage that best meets their needs.

The Affordable Care Act provides some new benefits to Medicare beneficiaries.  These benefits include some new free health screenings, free wellness visits, and a 50% discount on brand-name drugs for seniors who fall into the donut hole.  Open enrollment materials will have information on these new benefits. 


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Sandra L. Smith joined the firm in 2003. She practices primarily in the areas of elder law, estate planning, estate and trust administration, special needs planning, asset protection planning, long-term care planning and Veterans' benefits. Ms. Smith is certified as an Elder Law Attorney (CELA) by The National Elder Law Foundation (NELF).

In 2008, Ms. Smith was named as a Rising Star by Virginia Super Lawyers magazine. Rising Stars names the state's top up-and-coming attorneys.

  • Anonymous
    I have Medicare Advantage MA/PD and I chose zero premium plan with Northeast Community Care (which I believe is now Humana). I have spent approx $45 on drugs. What will change for me?