Professional Patient

Sign Up For/Change Your Medicare Prescription Drug Coverage by December 31, 2007

Between November 15 and December 31, 2007, anyone who is eligible for Medicare may sign up for a Medicare prescription drug plan (if you haven't had one before), or switch to a new plan for 2008 (if you hated the one you had in 2007). Enroll sooner (November or early December) rather than later to make sure your new insurance company has you in their files by January 1, 2008.

The good news is that if you like the plan you have, and don't want to change, you don't need to do a thing. You will automatically continue to be covered through that plan for 2008. Stop reading this post and go enjoy yourself.

New to Medicare Prescription Drug Coverage?

If you are signing up for Medicare prescription drug coverage for the very first time, AARP's "What is Medicare Drug Coverage" fact sheet includes basic information and key questions to ask when you are choosing between plans.

Considering a Plan Change for 2008?

There are plenty of reasons to choose a different Medicare prescription drug plan for 2008. Maybe the one you had was rotten... bad service, high premiums, high co-pays. Maybe your health situation has improved and you will need fewer prescription medications this year. Maybe you are simply curious about a different plan. The "Why Should I Consider Switching My Medicare Plan for 2008" page from the My Medicare Matters web site helps you think through whether a new plan might be better for you.

What Plans Are Available in Your State?

Some Medicare prescription drug coverage plans are only offered in certain states. To find full information (including rates) for plans in your state, go to the Medicare Prescription Drug Plan Finder web site. In the right column of text on the page, look for the banner heading "Learn More About Plans in Your Area". Pick your state from the drop-down list, and click "View Plans". The part of the screen you are looking for looks like this (I've selected Maryland, my home state, from the drop-down list):

For more information about plans available in your state, consider contacting your state's State Health Insurance Assistance Program (SHIP). State SHIP programs provide free counseling and assistance via telephone and face-to-face interactive sessions, public education presentations and programs, and media activities. To find the SHIP for your state, go to the "Find A State SHIP" web page on the SHIPtalk web site.

You may also find information about coverage options in your state in a local or regional newspaper. The Baltimore Sun, for example, recently published a wonderful summary of Maryland Medicare prescription drug plan options (see "Out of pocket comes bitter pill"), including tables that indicate the complaint rate and appeal success rate for each Maryland plan. According to the Sun article, Marylanders can expect to pay $75 to $100 for name-brand drugs in 2008.

Confused About The Damned "Doughnut Hole"?!?

The biggest, most infuriating (and care-depriving) aspect of Medicare prescription drug coverage is the so-called "coverage gap" or "doughnut hole" (or "donut hole"). It's a period of time when most plans will not pay a cent of your prescription drug costs. (They cover you up to a certain total $ amount, then you have to pay for everything out of pocket for a while, then your plan kicks back in with "catastrophic" coverage.)

"What will the Medicare Prescription Drug Coverage cost me overall?", from the My Medicare Matters web site, includes an easy-to-follow explanation of the dreaded "coverage gap" or "doughnut hole".

Angry Yet? Want A Better System?

I find the whole Medicare prescription drug plan situation appalling. I know entirely too many people who can barely pay these steep copays, yet have to because they really need the medications. Then, they hit the doughnut hole, and have to give up treatment altogether. It's an absolute travesty that we are letting this happen! Consider writing to your Senator or Representative to demand a better solution. To find contact information for your Senator and Representative, see "Write Your Representative" from the U.S. House of Representatives web site, or visit the Congressional Directory at the Congress.org web site.

Medicare Prescription Drug Coverage (Medicare Part D)

January has been tough. Dark, dreary, new job is very crazy busy. February could be worse. I will be back to serious blogging about health issues---soon.

In the meantime, a link to a good article on deciding what to do about Medicare Part D Prescription Drug coverage. Sign up!

http://www.msnbc.msn.com/id/10754239/site/newsweek/

Medicare Part D (Prescription Drug) Plan Enrollment Begins Nov. 15, 2005

Enrollment for the new Medicare prescription drug benefit (Medicare Part D) begins today and runs through May 15, 2005. Under the benefit, Medicare will pay benefits for certain prescription drugs--a first for Medicare.

If you are qualified for Medicare AND enrolled in Part A and B, you are eligible for the prescription drug benefit.

There are many different plans to choose from in each state; review your state's options and select the one that's best for you. In most cases, you must sign up for the prescription drug coverage--it won't just appear automatically as part of your Medicare benefits.  Sign up by December 31, 2005, for coverage that begins January 1, 2006.

One major exception: If you are enrolled in Medicaid, you are automatically signed up for the prescription drug benefit. You don't have to stick with the plan they assign you to, however. You may choose a different plan that works better for you.

To review the plan choices available to you, go to http://www.medicare.gov (the site was crashing when I wrote this post), or call 1-800-MEDICARE (1-800-633-4227).  TTY users should call 1-877-486-2048. You may review your plan choices and sign up for the one that best meets your needs.

For More Information
You may  find information on Medicare Part D on your state's Web site. Maryland, for example, presents some basic information (in the PDF links at the top right of the page) on its Web site. 

The Maryland Department of Aging Web site also notes that a special TV program, "Medicare RX: A National Conversation," will be airing Saturday, November 19, 2005, at 6:30-7:00 p.m. on CNBC.

NPR.com has a fantastic Q & A on  Medicare Part D.

Medicare PPOs to Reach Areas Under-Served by Medicare HMOs in NY, FL, MI, AZ, NV, and CA

Health Affairs is reporting that Medicare will soon spend as much as $60 billion to get PPOs to serve Medicare regions that are under-served or not served by Medicare HMOs. PPOs will offer coverage in these regions beginning in 2006. Likely winners: Medicare recipients in FL, NY, MI, AZ, NV, and CA. The PPO coverage will be more limited than that offered by HMOs, but will also likely cost less.

HMO: Health maintenance organization.
PPO: Preferred provider organization.

More information:
Basic information on Medicare Health Plan choices from Medicare.gov.
Medicare Advantage Plan introduction from the Centers for Medicaid and Medicare Services Web site.

UHC to Partner with AARP on Medicare Part D Drug Coverage

UnitedHealthCare will be teaming up with AARP to offer Medicare Part D prescription drug coverage in 2006. As AARP's full announcement about the AARP/UHC prescription drug partnership explains:

Currently, two million AARP members rely on AARP for prescription drug savings through United HealthGroup discount cards and Medigap policies that include pharmacy coverage. This partnership is a natural extension of a relationship that meets AARP members' need for high quality products and services.

Thanks to the isemmelweis blog (see article) for bringing this news story to my attention.