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March 2008 Medicare Part D Newsletter
:: Time for a Part D check-up: Online tools to see your Part D plan in action.
:: I think I am in the wrong Medicare Part D plan, can I still change plans?
:: Who Qualifies for a Special Enrollment Periods
:: Part D on the Road: How do I use my prescription drug plan when traveling?
:: Still considering enrolling in Medicare Advantage Plan?
:: Are all Medicare Advantage Plans the same?
:: Medicare Advantage Plans: Fact and Fiction!
:: Closing Notes
Time for a Part D check-up: Online tools to see your Part D plan in action.
Is your 2008 Medicare Part D plan all you expected?
We have a few tools designed to help you see how your prescription drug plan actually works so that you can properly budget throughout 2008.
PDP-Planner.com:
Our Annual Cost and Doughnut Hole Calculator — The coverage
gap or doughnut hole has caused a considerable amount of confusion for many
people and has even surprised seniors when they suddenly are required to pay
the full price of their medications. Use our PDP-Planner
to see an estimate of when you will enter and exit the doughnut hole, plus you
can see an illustration of your projected monthly prescription drug costs. You can even eMail yourself a copy of the cost estimates to help in planning your summer budget. Read
more about the Doughnut Hole here.
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I think I am in the wrong Medicare Part D plan, can I still change plans?
Now that you have had a few months with your Medicare Part D plan, what
do you do if you would like to change prescription drug plans?
Well, unless you are able to take advantage of a Special Enrollment
Period (SEP), you will not be able to change Part D prescription drug plans
before January 2009.
As many people have noted, most Medicare beneficiaries choose next
year’s prescription drug plan based on a "snapshot" of their medication needs during the 6 week Annual Enrollment Period (AEP or Annual Election Period). If their health changes during any given year, there is usually no way to change Part D plans until the next year begins. If you now need prescriptions not covered by your Part D plan, be sure to contact Member Services and see if you can have the medication added to the existing formulary (drug list). If necessary, get your physician involved and work through your plan’s appeal process.
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Who Qualifies for a Special Enrollment Periods
So who is able to change Medicare Part D plans outside of the Annual
Enrollment Period (AEP)? Here are some
of the most common Special Enrollment Periods (SEP) that provide you an
opportunity to change Part D prescription drug plans outside of the AEP:
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- You loose your creditable coverage through no fault of your own (for instance
when your employer coverage ends)
- You are institutionalized (such as entering/leaving a nursing facility)
- You qualify for the Low Income Subsidy, or receive Part D "Extra Help", or receive Medicaid, or SSI
- You move to a different Medicare Part D region
- See
more situations entitling you to a Special Enrollment Period
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Part D on the Road: How do I use my prescription drug plan when traveling?
Using your Part D benefit for local travel should not be a concern. When you travel within the United States, you need only to find a pharmacy that participates with your Medicare Part D prescription drug plan. Finding a participating pharmacy should also really not be a problem — most national Medicare Part D plans work with over 50,000
pharmacies across the country. You can telephone your plan’s Member Services department for a list of pharmacies within a certain ZIP Code or you can check your printed pharmacy list (although these are continually expanding) or your can check online with your Medicare
Part D plan.
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Still considering enrolling in Medicare Advantage Plan?
For those of you who are still considering the possibilities of a Medicare
Advantage Plan, the 2008 Open Enrollment Period (OEP)
is drawing to a close. If you wish to join
- or switch - or drop a Medicare Advantage plan for 2008 your
deadline is Monday, March 31. To begin
your search for a Medicare Advantage plan, you may wish to use the Medicare.gov
website. It will give you a list of the available Medicare Advantage plans in
your area.
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Remember, there are a number of options that you have with your Medicare
coverage, such as:
- Just stay with Medicare A (hospital coverage) and / or Medicare B (physician
services) and add Medicare Part D prescription drug coverage — or
- You can add a Medicare Supplement to your Medicare A and B and also add a Part D prescription drug plan — or
- You can join a Medicare Advantage plan that comes with prescription drug coverage
(an MA-PD)
— or
- You can join a Medicare Advantage plan that does not come with prescription drug
plan (an MA) and join a separate Medicare Part D prescription drug plan.
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Remember, during the OEP you cannot drop or add Part D prescription
drug coverage – however, if you already have a Medicare Part D prescription
drug plan (PDP), you can join a Medicare Advantage plan with a prescription
drug benefit (MA-PD). If you already have an MA-PD, you have the
option of moving to another MA-PD or returning back to a prescription drug plan
and original Medicare. Click here to learn more about Medicare Advantage Plans.
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Are all Medicare Advantage Plans the same?
No
— Medicare Advantage plans come in a variety of
forms and you should only enroll in a Medicare Advantage plan after you are
sure that you understand the coverage.
Unlike Medicare Supplements that are standardized across the country,
benefits provided by Medicare Advantage plans vary from plan to plan — and Medicare
Advantage plans also vary county to county.
So what is available to a friend in another state probably will NOT identically
match the same Medicare Advantage plan offered in your state and county. Also, there are a number of different types
of Medicare Advantage plans such as:
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Private-Fee-For-Service Plan (PFFS) —
This is a Medicare Advantage Plan in which you may go to any Medicare-approved
doctor or hospital that also accepts the plan’s payment conditions. In some situations, you may pay more or less
for Medicare-covered benefits. In
addition, you may receive extra benefits not provided by original Medicare. PFFS plans are often considered the most
flexible option because there is no existing network of physicians or
hospitals. The downside is that
physicians or hospitals can accept the PFFS coverage on a patient-by-patient or
visit-by-visit basis.
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Health Maintenance Organization (HMO) — This is a type of Medicare managed care plan where a group of doctors,
hospitals, and other health care providers agree to give health care to
Medicare beneficiaries for a set amount of money from Medicare every month. This
type of Medicare Advantage plan is usually defined in terms of a fairly
restrictive network – meaning you usually must get your care from the providers
in the plan’s network.
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Preferred Provider Organization (PPO) This type of Medicare Advantage Plan is
also defined by a network of doctors, hospitals, and providers. However, the
network is more loosely defined than the HMO Medicare Advantage plan where you
can also use doctors, hospitals, and providers outside of the network for an
additional cost.
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Medicare Advantage Plans: Fact and Fiction!
Are Medicare Advantage Plans the same as Medicare Supplements?
No
— Medicare Advantage plans are designed differently than Medicare Supplements or Medi-Gap policies. As noted above, Medicare Supplements are standardized across the country (Plans A through J) — Medicare Advantage plans are not standardized and can vary from company to company and county to county. Medicare Supplements work together, adding benefits to your Medicare Part A (hospital stays) and Part B (physician visits). Medicare Advantage plans work in place of your Medicare A and B plans and often provide benefits beyond typical Medicare coverage. Medicare Advantage plan benefits are also often presented in terms of co-payments ($XX
per night in the hospital) as compared to co-insurance (15% of the cost per night in hospital).
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Can you have both a Medicare Supplement and a Medicare Advantage plan?
Yes
— in theory it is possible, but you
would only be wasting money on duplicated services. As part of the enrollment process, insurance
carriers work to ensure that Medicare beneficiaries understand - and do not
duplicate coverage.
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Do you lose your Medicare when you enroll in Medicare Advantage?
No
— To enroll in a Medicare Advantage plan, you
need to have both Medicare Part A and Part B.
The insurance carriers will take over some of the administrative
processes to implement your Medicare benefits.
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Is it possible that a Medicare Advantage plans has a $0 premium or actually returns a portion of your Medicare Part B premiums?
Yes
— Insurance carriers receive a
certain amount of money from the US Government for each person enrolled in their Medicare Advantage plans. In some
counties there are so few "costs" that the insurance companies can implement
their Medicare A and B coverage and still have access funds remaining — these
funds are returned to the Medicare Advantage plan participants as a type "refund" on their Medicare Part B premiums.
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Is it true that some Medicare Advantage plans charge no premium for prescription drug coverage?
Yes
— However, there is really never
"something for nothing "- the Medicare beneficiary pays a monthly premium for
the Medicare Advantage plan and the plan is designed to use the premium to
cover Medicare Part A and Medicare Part B and Medicare Part D coverage.
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If I am not happy in my Medicare Advantage plan, can I go back to my original Medicare or Medicare Supplement coverage?
Yes
— During this Open Enrollment
Period (ending Monday, March 31), you can change Medicare Advantage plans or
return to original Medicare. If your
Medicare Advantage plan also has a prescription drug benefit, you can return to
original Medicare and enroll in a stand alone Medicare Part D prescription drug
plan. If you originally had a Medicare
Supplement and changed to a Medicare Advantage plan, you are allowed to return
to your original Medicare Supplement within 12 months
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Are there specific Medicare Advantage plans available for people who have specific medical conditions?
Yes
— First, no person can be denied
access to a Medicare Advantage plan based on their health — unless they suffer
from End Stage Renal Disease (ESRD).
However, some Medicare Advantage plans have started offering Special
Needs Plans (or SNPs) for Medicare beneficiaries with specific medical
conditions, such as Diabetes. These
Medicare Advantage plans are designed try to provide a different balance of
benefits to better meet the medical needs of a particular condition.
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Last updated on: 07/05/2009
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