Medicare Part D

it's only just begun

June 11, 2006|by Katrina Eversole

As the May 15 deadline approached for enrollment in Medicare Part D prescription plans, my colleagues, friends and seniors alike expressed the same sentiment; "I'll bet you'll be glad when it's over!"

Indeed, the initial enrollment period that began on Nov. 15, and continued through May 15, has passed. Seventy percent of Washington County's Medicare eligible individuals signed up for one of the 47 prescription drug plans offered in Maryland. That percentage represents the norm across the country. However, this is not the last you'll hear about Medicare Part D, which signifies the greatest change in Medicare since its beginnings in 1965.

Medicare beneficiaries in Maryland had several state-assistance programs to cover all kinds of prescription needs, but found that due to the Medicare Modernization Act of 2004, their coverage would cease - in most cases, by the end of 2005.

The federal government made it very clear that there was only one choice to make - either enroll in Medicare Part D or not.


There were exceptions:

1. Those who continue to receive "creditable" coverage (as good as or better than Medicare's plans) through their employer group coverage as stated in a letter or public notice sent to them.

2. Those who can take advantage of the Veterans Affairs Center.

3. Those who are enrolled in FEHB (Federal Employees Health Benefits) or TRICARE.

Rules may change and companies offering Part D plans may merge, but individuals will have annual open enrollment periods each year from Nov. 15 through Dec. 31.

Those unhappy with their coverage in a PDP (prescription drug plan) or MAPD (Medicare Advantage prescription drug plan) will have a right to switch then.

This also means that there will be a "crunch time" of six weeks to help Medicare beneficiaries find a better Part D plan by holding enrollment events with one-to-one assistance at a computer terminal, just as we did during the first six-month enrollment period.

Those who chose not to enroll during the initial enrollment period (with exceptions below) will now have to wait until Nov. 15 to sign up. There will be a 1 percent penalty per month (figured on the national average of a Part D plan - which is 32 centsfor 2006) for each month that enrollment was delayed, and coverage will not begin until Jan. 1, 2007.

Individuals who are exempt from the monthly penalty and who need not wait for Annual Open Enrollment to join a Medicare Part D plan include:

1. Those who become eligible for Medicare, either by virtue of the fact that they have a disability, or are turning 65 years of age, have a seven-month period of time to enroll in a Part D plan: Three months before their eligibility, the month of their eligibility, and three months after their eligibility marks a "special enrollment period."

2. Those who lose "creditable" coverage with their former employer group plan will have the right to choose a plan within a certain time frame, if they can produce the notice stating that their plan was better than the federal government's but now is ending. That notice will preclude penalties.

3. Those who become eligible for "extra help" or LIS (low-income subsidy) through Social Security may sign up for a Part D plan when an approval letter is received from SSA. An individual may apply for "extra help" through Social Security at any time.

Also, those who are considered "dual eligibles" - those who have Medicare as well as Medical Assistance AND those who are eligible for state assistance programs known as QMB (Qualified Medicare Beneficiary) and SLMB (Specified Low-Income Medicare Beneficiary) will be able to switch plans at any time during the year.

The work continues at the Washington County Commission on Aging, as there are problems and "glitches" in the system that need to be resolved.

Katrina Eversole is the Washington County Commission on Aging's senior Health insurance program manager.

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