Things to remember before enrolling in Medicare

Over the past two months I have had more phone calls than I can answer or return. All these calls are about Medicare Prescription Drug Program (Medicare Part D).There have been seminars presented, by me and others, attempting to educate Medicare recipients about Medicare Part D. I believe there is more confusion now than before the seminars started. Much of this confusion is caused by information being mailed to you regarding the individual prescription drug plans.

I know many of you have called my office and left messages for me asking me to call you needing information on how to choose a Medicare Prescription Drug Plan. I have not been able to return the majority of those calls because of the presentations I have been making. My schedule has taken me out of the office most of the month of October.I will try to return those calls as soon as I can. For now, I hope I will be able to answer some of the questions you ask in this column. So in this month's column, I thought I would let you know some facts that perhaps would put some of you at ease.

First, don't panic. Initial Open Enrollment began Nov. 15 and will end May 15, 2006. If you find a plan and are able to enroll prior to Dec. 31, 2005, your prescription coverage will begin January. No penalty will be assessed to anyone unless they fail to enroll by May 15, 2006. There are going to be several enrollment clinics within driving distance to you. Watch your local newspapers for the schedules and contact numbers. You may call and make an appointment to see a counselor who can assist you in enrolling, and you can talk to 1-800-Medicare for information and to enroll.

Second, persons receiving prescriptions through Texas Medicaid will be auto enrolled in a Medicare Prescription Drug Plan before Dec. 31, 2005. You will begin receiving letters this month advising that you have been or will be "auto" enrolled in a plan prior to Dec. 31. Many of you have already received your plan enrollment letters. The auto enrollment plans are selected at random and may or may not cover "all" of the drugs you take. It is very important that you have someone go into www.medicare.gov(Medicare Website) and enter your medications to make sure you receive a plan that does cover "all" your drugs. You may change the plan one time between Nov. 15 and Dec. 31 by enrolling in another plan. Enrollment by Dec. 31 will begin your coverage on Jan. 1, 2006. People receiving QMB, SLMB and QI will be auto enrolled in a plan by May 15, 2006, if you do not select a plan before that date. Again, I strongly suggest that you have someone help you through the Medicare Website to select your plan or call Medicare for assistance.

A word of caution, however, before enrolling in a plan, make sure you do not enroll with any plan without having your medications and pharmacy entered in the Website. You will be, if not already, receiving many solicitations from insurance companies wanting you to allow them to enroll you in their prescription plan. Beware. Medicare's rules for enrollment do not allow any insurance company to enroll you in a plan if they initiate the call. In other words, if a company calls you and offers to enroll you in a plan and asks for your Social Security or Medicare number, birthday and other important personal information over the phone, do not give that information to them. To enroll in a company's prescription plan, YOU must initiate the call to that company. This is very important. Many scams and frauds are being done on unsuspecting Medicare recipients by asking for their important information and receiving it. Some scams and frauds are asking for money up front to enroll Medicare recipients in a drug plan. According to Medicare, no company can legally ask for any money up front when enrolling a Medicare recipient in a drug plan. If anyone calls you about enrolling in a prescription plan, ask for their name and phone number in order for you to call them back. Just remember, "when in doubt, don't do it".

Take your time in selecting a Medicare Prescription Drug Plan. Things to consider are the cost of your drugs verses the cost of your drugs when purchased from a prescription drug plan. Some plans have a "0" yearly deductible and a more expensive monthly premium while others have a "$100 or $250 yearly deductible and little or no monthly premium. Look at your options. Try to determine whether it is more feasible to pay a higher yearly deductible with little or no monthly premium or no deductible and have a more expensive monthly premium.

For example, your prescriptions costs now run about $100 per month. You could choose a plan with a "0" monthly premium and a $250 yearly deductible. You would have met your deductible in less than three months. The rest of the year, you would have no expense other than the amount your plan charges for your prescription. Spending no more than $100 per month or less on prescriptions, you will never reach the $3,600 out of pocket expenses and the catastrophic coverage.

On the other hand, your prescription costs run $1,500 per month. You choose a plan with a $250 deductible and a "0" or low monthly premium. You will have reached your $250 deductible the first month and $3,600 "out of pocket expense" by the third month. Your prescriptions would then cost no more than $2 for generics and $5 for brand names.

I am asked over and over again, "I only take one or two medicines costing less than $100 per month.Should I enroll in a plan?" Yes, you can choose a plan that has a "0" or low monthly premium. You would therefore avoid the 1 percent per month penalty charged to persons who do not enroll by May 15, 2006. I encourage you to enroll in a plan even if you take no medications. Go to the Medicare web site or have someone assist you in picking a plan with "0" monthly premium. Should you, at a later date, begin to take medications, you will be enrolled in a plan, again, avoiding the 1 percent monthly penalty for not enrolling by May 15, 2006.

Each year, open enrollment will be from Nov. 15 to Dec. 31. You should review your plan yearly to search for a better deductible or monthly premium. Remember, Medicare Prescription Drug Plans are insurance. Insurance just like your car, home or fire insurance so shop, shop, shop to find the best plan for you. Insurance companies will compete with each other to provide better coverage and lower prices. You can change your plan each year from Nov. 15 to Dec. 31. If you find a better plan, change it.

I wish I could help each and every one of you personally, but with the amount of Medicare recipients in the nine counties the Area Agency on Aging covers, that is impossible. Just watch your paper for a schedule of enrollment sites and dates, call for your appointment, and, be sure to bring your medications and Medicare card when you come.

I appreciate your response to this column and the attendance at the seminars I have presented. I will try to continue to bring more and new information to you through the generosity of the Texarkana Gazette Active Age so keep reading.