The Med Diva

An insider's guide to Medicare Part D and more

Archive for the tag “MA-PD”

The Countdown to Medicare Part D Open Enrollment Is Over

Open Enrollment for 2012 begins today, October 15, and ends on Wednesday, December 7, 2011.

The 3 eligibility windows for joining or switching Part D plans

Since today is the start of the Annual Coordinated Election Period (or Open Enrollment), I thought I’d give a quick review of the 3 eligibility windows for joining or switching prescription drug plans.

1. Initial Enrollment Period
2. Open Enrollment Period
3. Special Enrollment Period

1. Initial Enrollment Period

If you are turning 65 and newly eligible for Medicare, you have 7 months to enroll in a Medicare Part D plan:

  • Up to 3 full months before you turn 65
  • During the month of your 65th birthday
  • Up to 3 full months after you turn 65

If you join during the 3 months before you turn 65, your coverage will start on the first day of your birthday month. If you join during or after your birthday month, your coverage will begin on the first day of the next month.

For example, let’s say Patricia is going to turn 65 on May 10, 2012. Her eligibility window will be from February 1 to August 31, 2012.  If she enrolls in a plan any time in February, March, or April, her coverage will begin on May 1. If she waits to join on her birthday, her coverage will begin the following month, on June 1.

If you get Medicare due to a disability, you can enroll in a Medicare Part D plan:

  • Up to 3 months before the 25th month of your disability
  • Up to 3 months after your 25th month of disability
  • During your Initial Enrollment Period when you turn 65

2. Open Enrollment Period

If you are already in a Medicare prescription drug plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD), you can switch to a new Medicare Part D plan during the Open Enrollment Period from October 15 through December 7.

3. Special Enrollment Period

Outside these two windows above, you may only switch plans if you qualify for a Special Enrollment Period (SEP). For example, you may qualify for an SEP for the following reasons:

  • You lose creditable coverage (coverage as good as or better than standard Medicare) through no fault of your own
  • You move to a new permanent address that is not in your current plan’s service area
  • Your current plan no longer offers prescription drug coverage
  • You receive Medicaid or get Extra Help with Part D costs
  • You are enrolled in a State Pharmaceutical Assistance Program (SPAP)

How to avoid a late-enrollment penalty

I talked a lot about the late-enrollment penalty yesterday, but I want to remind you again that if you choose not to enroll in a Part D plan when you first become eligible, Medicare will impose a monthly penalty if you join later. To avoid paying a late-enrollment penalty:

  • Make sure you join a Part D plan during your Initial Enrollment Period.
  • Be sure to enroll in a plan within 63 days of not having a Part D plan or other creditable coverage, such as coverage from:
    • A current or former employer or union
    • Department of Veterans Affairs
  • Let your new prescription drug plan know within 63 days if you had other creditable coverage (your former plan must send you a letter called “Notice of Creditable Coverage,” which you can use as proof of coverage when you join a new plan).

Countdown to Medicare Part D Open Enrollment: Day 16

Open Enrollment for 2012 begins on Saturday, October 15, and ends on Wednesday, December 7, 2011.

  Day 16: Let the Medicare Part D Marketing Begin

If you’re currently enrolled in a Medicare prescription drug plan (PDP), Medicare Advantage (MA) plan, or Medicare Advantage with Prescription Drug Coverage (MA-PD) plan, you should have already received your Annual Notice of Changes (ANOC) and Evidence of Coverage (EOC) documents. The Centers for Medicare & Medicaid Services requires plans to ensure that current members receive the ANOC/EOC by September 30, 2011. If you haven’t received your documents yet, call your plan immediately to make sure they have your correct address on file.   

The ANOC and EOC will tell you what your new monthly premium and annual deductible (if any) will be for 2012. They will also procide information about the drugs covered and the co-payments or coinsurance amounts that you will pay in each stage of your benefit.

Even if you are satisfied with your plan in 2011, you still need to review your plan options for 2012

It’s important to carefully review your ANOC and EOC as soon as possible to determine if you want to stay with your current plan or make changes for the coming year. All plan sponsors must contract on a yearly basis with the Medicare program, which permits changes to formulary lists (the list of drugs covered by the plan), restriction and limitation requirements, monthly premium payments, and co-payments or coinsurance. So, for example, if your plan no longer covers a drug that you take on a regular basis, or if the monthly premium has increased more than you expected, you may want to look for a plan that better meets your health and financial needs.

If you do decide that you need to change plans, remember you can only enroll in a plan or switch plans between October 15 and December 7.  After December 7, you will not be able to change yourMA,MA-PD, or PDP plan for 2012 unless you qualify for a Special Enrollment Period.

Starting October 1, 2011, plan information for 2012 will be available on the Medicare Plan Finder on Medicare’s website. MA and PDP plan sponsors can also start marketing their plans on October 1, so expect to get inundated with marketing materials over the next two months. Please keep in mind that Medicare plan sales agents can not do the following: 

  • Come to your house without an invitation from you
  • Approach you in parking lots, hallways, or lobbies
  • Offer you a gift worth more than $15 to join their plan
  • Provide free meals at Medicare sales presentations
  • Try to sell you a plan at educational events and seminars

Over the next few weeks I will be giving you lots of helpful tips, money-saving suggestions, and important things to consider when comparing Medicare Part D coverage.  I’ll also cover Special Enrollment Periods, Medicare star ratings, the Coverage Gap, and other Medicare topics that may not make a lot of sense to you right now, but are nonetheless important to understand in order to make the most of your benefit.



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