Open enrollment starts saturday for Medicare part D coverage

Wednesday, November 12, 2008

A new season starts this Saturday. Not only is it the first day of the firearms deer season, but it is also the beginning of the open enrollment period for Medicare Advantage and Part D prescription coverage. The open enrollment period will end on Dec. 31. What this means is that those on Medicare may sign up for Medicare Advantage programs during that time, change plans, or leave a Medicare Advantage plan to go back to original Medicare.

The open enrollment period is when people can enroll in Part D or make changes in their Part D coverage by moving from one plan to another. Those going on Part D and have not had creditable coverage since they were eligible will have to pay a penalty of 1 percent of the standard premium for each month they were not enrolled. The standard premium being used for 2009 is $30.36. Those on Medicaid or receiving subsistence on their Part D premiums do not have any penalty.

There have been many changes made regarding enrollment for Medicare Advantage and Part D plans for this year. Among them is that the insurance agents selling the plans for the private companies have new rules to follow. You will notice that you will not be getting calls from agents trying to sell the products. That is because the agents are no longer allowed to make calls. They can call their own customers but that is all. Even then they are limited on what they can say. They can also call those who have returned a lead card. The Medicare beneficiary has to call the agent or go by their office to seek information on Medicare Advantage or Part D plans.

The agent is required to send a sales appointment confirmation form and have it returned by mail before visiting about the products. They are allowed to discuss Medicare supplements, but are not allowed to doing any cross selling. In order to present other products such as life insurance or annuities, they must make another appointment least 48 hours later.

Meals will not be allowed at seminars. Light refreshments are acceptable. CMS has added more secret shoppers. These secret shoppers attend seminars and do other things to make sure that agents are following the guidelines and presenting approved information and not using any pressure or presenting the wrong information.

There are many other guidelines that agents must follow including being certified for the companies and plans they represent. Penalties are severe for those caught doing things improperly, not only for the agent, but also for the companies.

Changes have also been made that will provide more help for those with low income. The changes and the new rules and regulations were made to protect the consumers and prevent them from being confused and signing up for something they do not want or would be of no advantage to them.

A Part D plan that a person had for 2008, may have changed for 2009. At least one company has had a 60 percent increase in premiums. What formularies they represent can make a difference on which plan is best. It is a good idea to evaluate the plans with the prescriptions that are being taken to determine which plan is the best. This is a good practice for each of the annual enrollment periods.

Some may want to consider Medicare Advantage Plans. While some people have been advised to not consider Medicare Advantage Plans and sign up for a Medicare Supplement, there are Medicare beneficiaries that could profit by enrolling in a Medicare Advantage Plan. This is the time to review alternatives. Certainly, there are advantages for many to be enrolled in original Medicare with a supplement. On average those with a private fee for service plan will save $800 annually. Many have enrolled in a private fee for service plan and are happy with it primarily due to a low premium.

Nationally, of those enrolled in Medicare, 21 percent have original Medicare with a supplement, 33 percent have Medicare only, 13 percent have Medicare Advantage (this is growing), 10 percent is employer sponsored, and others have Medicaid or something similar. Because of their health many people with Medicare only may not be eligible to enroll in a supplement plan and might find a Medicare Advantage to be an advantage.

Only a small portion of those on Part D reach the donut hole where most plans do not have any coverage. It does not seem that way for those who do get in the donut hole, but there is help available for many people by contacting Social Security to see if the person on Social Security can qualify for help with the premiums and co-payments. It is suggested that everyone apply for the assistance at Social Security.

MoRx is a special program designed to work with all Medicare Part D plans. It will pay for 50 percent of your out-of-pocket costs on medications that are covered by your Medicare Part D plan. This means you will save 50 percent on your deductible, 50 percent on your co-pays and 50 percent during the coverage gap and beyond. MoRx does not pay for the Medicare Part D Plan's monthly premium. Qualification requirements is under $20,800 gross income for single, widowed, divorced, or live apart from your spouse or under $2,800 gross income for married couples. For additional information and a form go to