The Annual Open Enrollment Period for Plan D has come and gone. Changes except for special enrollments cannot be made until the next Open Enrollment Period, Nov. 15 to Dec. 31, 2007. In many ways, it was a rapid 45 days. Truly, there remains a great amount of confusion. Many older citizens are confused and do not understand.

Anyone signed up by Dec. 31 has an effective date of Jan, 1, and there are insurance agents commenting that there needs to be a change. The enrolment period should be from Oct. 15 to the last of November for an effective day of Jan. 1. Or, have the same period as it is now, but effective Feb.1. That way, there would be more time between enrollment and the effective date -- more time to get the applications processed and information to Medicare Beneficiary.

At the present time we are in the Limited Open Enrollment Period -- Jan. 1 to March 31 -- a time to enroll in Medicare Advantage plans. Again, it is confusing and difficult to understand what can be done and what cannot be done.

For many, Medicare Advantage is a new term, one that we will most likely hear much more of in the future. Many may be asking, "What is Medicare Advantage?" Every person on Medicare should have received the Centers for Medicare and Medicaid publication, "Medicare & You, 2007." If not, the publication is available at the Social Security office. This publication says that the Medicare Advantage Plans are health plan options that are approved by Medicare and run by private companies. They are part of the Medicare Program, and sometimes called Part C. When you join a Medicare Advantage Plan, you are still in Medicare. Some of these plans require referrals to see specialists. In many cases the premiums of the costs of services (co-pays) can be lower in a Medicare Advantage Plan than they are in the Original Medicare Plan or the Original Medicare Plan with a Medigap policy.

Medicare Advantage Plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically necessary services. They generally offer extra benefits, and many include Part D drug coverage. These plans often have networks, which mean you may have to see doctors who belong to the plan or go to certain hospitals to get covered services. In many cases, your costs for services can be lower than in the Original Medicare Plan. Some of these plans coordinate your care, using networks and referrals, more than others. This can help manage your overall care and can also result in savings to you.

Medicare Advantage Plans include: Medicare Preferred Provider Organization Plans, Medicare Health Maintenance Organization Plans, Medicare Private Fee-for-Service Medicare Special Needs Plans and Medicare Medical Savings Account Plans. Basically the PPO plans and HMO plans are not too available in this area, but exist in places such as Kansas City and Springfield.

PFFS plans are available in this area and were new in 2006. Last year only about two companies were in this area, there are more now. It has been reported that those who enrolled in a PFFS Plan saved approximately $100 per month. As one person who represented a Plan D company said on a phone conference there are good PFFS Plans and there are bad ones.

Among the people who will find a PFFS Plan to be of advantage are those who never enrolled in a Medicare Supplement and now their health will prevent them enrolling. PFFS plans are certainly not for everyone, but for many they will be well worth checking out.

New legislation, signed by President George W. Bush, extends the Medicare Advantage Plans from the Limited Continuous Open Enrollment from March 31 through all of 2008, known as Limited Continuous Open Enrollment. Medicare Advantage Plans may or may not include Part D.

During these open enrollment periods there are certain limitations on what can be done during that period. If an enrollment is with a Medicare Advantage plan on April 1, the enrollment is locked in until Nov.15 and cannot be changed.