FWD:RSDSA-Medicare 2007 Annual Enrollment Period has begun

The 2007 Annual Enrollment Period for Medicare’s Prescription Drug Coverage Has Begun and Continues Only Through December If you have Medicare—whether because you are 65 or older or because you are considered disabled by Social Security—the Annual Enrollment Period for Medicare’s prescription drug coverage is the time to think about your prescription drug coverage, whether you already enrolled in Medicare Part D or not. (If you do not yet have Medicare but will soon be eligible, you can make a decision about Medicare Part D when you enroll in the rest of Medicare.) There are several new plans available and many changes to current plans, and some plans are ending their Part D participation, so it is definitely wise to think about your prescription drug coverage now. Anyone with Medicare is eligible for Part D, but Part D is not always the best choice.

Medicare began to provide voluntary prescription drug coverage in January 2006. If you signed up for a 2006 Medicare Part D plan and did not receive any help in paying for Part D, look now at your current plan’s benefits for 2007. If you want to change plans, you must do so by December 31 (although Medicare encourages you to make the decision by early December so that the change is processed by January 1). Because many plans have made significant changes, anyone with a Part D plan is strongly advised to look at what the plan will offer in 2007 and how much the plan will cost you in monthly premiums, deductibles, and co-payments/co- insurance. It may be especially important to look at whether your medications will have quantity limits or require prior authorization from the plan (which requires your doctor to complete a form) or step therapy (which requires you to try other medications first and to not do well with the cheaper drugs). In addition, your medications may be in a more expensive level or tier, so what you pay for them may cost you more next year. All changes should be explained in the “Annual Notice of Change” that your plan was to send in October.

To examine your current plan’s benefits for 2007 and to look at other options, you can also use the Medicare Plan Finder Medicare Plan Finder. The Medicare Plan Finder has even more tools this year than last, so you may find it very helpful, especially because even more Part D plans are available for 2007 than 2006. And remember that you may be eligible for help with your prescription drug costs: it is always worth asking if you qualify for the Part D low-income subsidy (also called the “extra help”), especially if your financial situation has changed at all. To see what programs may help you, visit www.benefitscheckup.org/.

If you were enrolled in Part D for 2006 and you have Medicare and Medicaid (including Medicaid that qualifies you for a Medicare Savings Program), you received the Part D low-income subsidy (also called the “extra help”) and now you may be put in a different plan. If the premium increased by a certain amount, Medicare will assign you to a different plan, so you should have received a letter with information about the assigned plan. However, if you have Medicare and any Medicaid (including Medicaid that qualifies you for a Medicare Savings Program) and do not like that plan, you can change plans at any time with the new plan effective the following month. The packet about the assigned plan should explain more about the plan, but to examine your current plan’s benefits for 2007 and to look at other options, you can also use the Medicare Plan Finder www.medicare.gov/. The Medicare Plan Finder has even more tools this year than last, so you may find it very helpful, especially because even more Part D plans are available for 2007 than 2006.

Note that most people who received Medicare and Medicaid (including Medicaid that qualifies you for a Medicare Savings Program) in 2006 are automatically considered eligible for the extra help, but if you no longer receive Medicaid benefits, you will not automatically receive the extra help. You should have received a letter a few months ago telling you whether or not you would automatically receive the extra help. If you needed to re-apply, you should have received the application for the extra help. If you have not yet re-applied, do so as quickly as possible.

If you were enrolled in Part D for 2006 and you received the Part D low-income subsidy (also called the “extra help”) but do not have any Medicaid benefits at all (including Medicaid that qualifies you for a Medicare Savings Program), you may be moved to another plan if the premium increased by a certain amount. If the premium increased by a certain amount, Medicare will assign you to a different plan, so you should have received a letter with information about the assigned plan. It is very important for you to look at the plan and its costs and list of covered drugs as well as the costs of the drugs. If you do not like that plan, you generally cannot change plans after December 31 but will have to keep it until January 2008. The packet about the assigned plan should explain more about the plan, but to examine your current plan’s benefits for 2007 and to look at other options, you can also use the Medicare Plan Finder www.medicare.gov/. The Medicare Plan Finder has even more tools this year than last, so you may find it very helpful, especially because even more Part D plans are available for 2007 than 2006.

Not everyone who received the extra help this year will get it for next year. You should have received a letter from the Social Security Administration a few months ago telling you whether or not you would automatically receive the extra help. If you needed to re-apply, you should have received the application for the extra help. If you have not yet re-applied, do so as quickly as possible.

If you do not have Medicare Part D, now is the time to consider whether or not you should get it. You may be better off not joining a Medicare plan if you already have other drug coverage that is as good as or better than a Medicare plan (“creditable coverage”). If you have prescription drug coverage now through a spouse, for example, or through a former employer, you should have received a letter by now telling you whether or not the coverage is creditable for 2007. (Coverage that was creditable in 2006 may have changed and may no longer be creditable.) If it is creditable, as long as you keep it, you do not have to think about Medicare enrollment deadlines. If it is not creditable or if you do not have any prescription drug coverage now, Medicare's prescription drug plans may benefit you.

Medicare's prescription drug coverage, known as Part D, is a voluntary or optional program; you must choose and enroll into a plan if you want the Part D coverage. If you are already in Medicare but for some reason you did not participate in Part D last year but now want to join, you can do so by December 31, the end of the Annual Enrollment Period (although Medicare encourages you to make the decision by early December so that the change is processed by January 1). Most people pay a monthly premium for Part D (just as there is a premium for Medicare Part B which covers many out-patient services), and many people with low incomes and certain limited assets (like a savings account) can get help paying the costs of Part D. It is always worth asking if you qualify for the low-income subsidy (also called the “extra help”), especially if your financial situation has changed at all. To see what programs may help you, visit www.benefitscheckup.org/.

If you are just joining Part D now and have not had creditable drug coverage for more than 63 days, you have to pay a small penalty (usually around 7% of the premium) unless you are eligible for the low- income subsidy. Delaying Part D because of the premium penalty may not be wise: the longer you wait to join Part D, the higher the premium will be. At the same time, the cheaper the premium, the cheaper the penalty, and some plans have very low premiums. However, these plans are not always the best choice for people with conditions like RSD/CRPS who have high drug costs.

There are many plans available around the country, and because there are so many plans with different costs and different lists of drugs covered (formularies) and different rules on prior authorization, quantity limits, and step therapy, it can be extremely difficult to choose a Part D plan that is right for you. Moreover, under the law, Part D plans cannot cover certain categories of drugs, including the benzodiazepines that are sometimes used by people with RSD/CRPS (such as clonazepam or Klonopin and alprazolam or Xanax). Yet if you have Medicare and no prescription drug coverage (or limited drug coverage, such as a standard Medigap prescription drug coverage plan), you may still find Part D valuable. Just remember that if you already have prescription drug coverage that is as good or better than a Medicare plan (“creditable coverage”), including a retiree plan, signing up for Part D may mean that you and any of your dependents (such as a spouse or a child) on that policy can lose that entire health coverage permanently.

If you do not enroll in a Part D plan by December 31, 2006 and you do not now have other drug coverage that is as good as or better than a Medicare plan (“creditable coverage”) and you cannot get a special enrollment period, you will generally not be able to get drug coverage through Medicare until January 2008. In addition, the law says that the longer you wait to join Part D without having creditable coverage, the more of a penalty you will pay— in the form of higher Part D monthly premiums—for as long as you have a Part D plan.

If you have any questions about Medicare's prescription drug coverage, you can contact Christin Engelhardt, who is working on health insurance issues for the RSDSA, at rsdsa-dc@hotmail.com.