'Tis the Season for Mediciad Open Enrollement
by Amos Goodall
It is that time of year again - time to reassess whether your Medicare plan is working for you. Medicare's open enrollment period began Nov. 15 and continues to Dec. 31.
During this period, you may enroll is Medicare Part D plan or, ifyou currently have a plan, you may change plans. You also can switch out of a Medicare Advantage (managed care) plan, enroll in or change Medicare Advantage Plans.
If you are enrolled in PACE or PACENET, it is important that you be enrolled in a "partnered" plans; for 2008 there are only five such plans: AmeriHealth Advantage Rx Option 1: MemberHealth (Penn Life) Community CCRx Basic; RxAmerica Advantage Star Plan; SilverScript; and UHC/AARP Medicre Rx Saver.
PACE authorities have taken stops to transfer participants to these plans, but it is important for PACE and PACENET subscribers to confirm that they have been properly enrolled in the appropriate plan.
If you are enrolled in a Medicare Advantage Plan, you should check your specific plan, because for most such plans, you should probably not be enrolled in a stand-alone prescription plan because it may void the balance of your medical coverage. If you are in a Medicare Advantage Plan, the entity administering the plan can give you more information.
If you have a Medicare prescription drug plan, you should look carefully at your plan because premiums are expected to rise on most drug plans.
According to the Kaiser Family Foundation, three-quarters of Medicare beneficiaries enrolled in stand-alone drug plans could face premium increases in 2008, and the average monthly premiums will increase 17 percent if enrollees do not switch plans.
At www.medicare.gov/MPDPF, you can evaluate stand-alone drug plans. the Web site allows you to enter the list of medications you take to determine the amount that each prescription drug plan charges for premiums, co-payments and deductibles. It also allows you to compare Medicare prescription drug plans based on customer service and other areas.
In addition, you can compare Medicare Advantage and origianal Medicare plans at www.mediare.gov/MPPF.
Some factors to consider when evaluating your drug plan include:
- What is the monthly premium?
- Does that plan continue to cover necessary drugs?
- Does the plan provide coverge drugs in the doughnut hole or coverage gap?
- What pharmacies are covered under the plan?
Some factors to look at when comparing Medicare Advantage plans include:
- What is the monthly premium?
- What is the cost sharing for doctor visits?
- Which doctors and hospitals are covered?
- Are any extra benefits included?
The Centre Law Web site (www.centrelaw.com) has a more detailed discussion of these options and a checklist to use to allow a meaningful comparison of various plans.
In Pennsylvania, certain prescription drug plans have entered into partnership agreements, listed at teh beginning of this column. For a PACE member, Pennsylvania will pay the premium for a partnered stand-alone plan. For a PACENET member, Pennsylvania will advance the premium for the partnered plan, collecting it back from the recipient as prescriptions are filled.
The department of Aging maintains a Web site discussing prescription drug coverage for Pennsylvanians, https://pacecares.fhsc.com, and a telephone hotline, 800-225-7223, for the same purpose.