Medicare Advantage & MedicareRX Annual Enrollment

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Find Out More About the Medicare Enrollment Period

Well, it’s time again and this year many Caterpillar management retirees are facing these decisions. Again you will be bombarded by mailings, flyers, and TV commercials about all of the Medicare Advantage (MA) and Medicare Part D Prescription Drug Plans (PDP). Beginning on November 15th to December 31st you can change your MA and/or PDP plans or enroll in a MA and/or PDP during Medicare’s Annual Enrollment Period (AEP). (this writers note – it is best to make any changes prior to December 15th so that all information is in the company’s hands and confirmed by 12/31)

Remember the background – the Centers for Medicare and Medicaid Services (CMS) has allowed private insurance companies to administer Medicare’s health MA and PDP programs. For your safety, these insurance companies must abide to strict regulations while offering these Medicare plans. However, not all programs are alike. Most importantly, these plans can change from year to year. Changes could include co-pays – dollar amounts or coinsurance percentage (your payment amounts), providers that will agree to accept the plan’s network or the plans terms and conditions, for plans which include prescriptions, the formulary list or drugs covered; and plan premiums.

There are basically 3 types of MA plans: HMO where must stay in network, PPO where you have better benefits if you are in the preferred network, and Private Fee for Service Plan (PFFS) where you can use any provider that accepts the terms and conditions of that company’s plan. Note: providers can choose to accept the PFFS plan this time, but choose not to accept the plan next time.

Considering MA plans (HMO, PPO, PFFS), you can ask to have your prescriptions covered on the same plan. This is called a MAPD. This may or may not be of benefit to you depending upon the plan and the prescription you take.

MedicareRX’s Standard Plan will change for 2010. While these plans must be at least as good as governmental “Standard Plan” guidelines, many plans will be considered better. Standard Plans will have a $310.00 annual deductible, then 75% coverage of annual drug costs up to $2,830. After $2,830 and until your out of pocket drug costs exceed $4,550, the Standard Plan has its gap (also called the donut hole) and you pay 100%. The catastrophic coverage begins after your out of pocket costs exceed $4,350 and basically the Standard Plan will pay 95% (or $2.50 for generics – $6.30 for preferred brands if greater than 5%)

Even more important than premium changes from 2009 are changes in a company’s formulary list. A formulary drug is a drug covered by that company’s plan. January 1st of every year is also when the plan’s benefits and formulary may be changed. Ask specifically if the drugs (names) that you currently take are on the company’s formulary (preferred) list. It is recommended that you should review your plan according to your situation during the AEP

Remember to enroll in Medicare Part B, D, and if you choose Part C; timely (3 months before, three months after and the month of your 65th birthday). This is called your Initial Enrollment Period (IEP). You also may have a Special Enrollment Period (SEP) if you loose other creditable coverage. If you do not enroll timely, You may not be enter the plan you want and in the case of Medicare Parts B and D once you do enroll you could have a lifetime penalty increasing for every month you were not enrolled.

Very important: If you currently have other creditable prescription coverage (from current or past employment, etc) or a PPO or HMO “Medicare Advantage” plan, contact that company. You may loose that plan if you enroll in another company’s Part D MedicareRX plan.

As you see, this is an area of expertise. As you gather information, be sure to get advice from a qualified professional that focuses on Medicare, Medicare Advantage Plans, and Part D.

People may qualify for “Extra Help” financial assistance with prescription drugs. As a rough rule, if your assets (excluding your home, cars, possessions, burial plot) are under $15,510 for a single person, $25,010 for a couple and your income is limited you may qualify for assistance (these are 2008 figures). If in doubt you should complete the paperwork or make a website application. As resources you may contact the Social Security Administration at 1-800-772-1213, or visit www.socialsecurity.gov/prescriptionhelp on the web.

A separate program offered through the State of Illinois is called Illinois Cares RX . This program offers two programs for drug cost assistance for Illinois residents – Illinois Cares RX “Basic” and “Plus”. The 2009 guidelines may provide help for residents that are 65 or older and people with disabilities age 16 and over who have annual incomes no more than: Basic: $25,532 for individuals, $33,877 for you and one more person. For benefits and more information contact the Senior Help Line at 1-800-252-8966 or www.illinoiscaresrx.com.

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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