Open enrollment will bring many choices

Most of the Medicare beneficiaries are enrolled in the new prescription drug program, Plan D. The experiences with this program vary from a bad experience to good. Most are satisfied with the program.

For many the "gap," which may be referred to as the "doughnut hole" has been or is a major problem, this is the period that the person has to pay the entire cost for the drugs. This is something that many cannot do. Still, once through the "doughnut hole," the prescriptions cost the Medicare beneficiary a small amount. At least one plan paid during the "doughnut hole." However, one of them that did in 2006 will have larger premiums and only pay for generics in 2007. There are other plans that will pay for generic drugs during the gap in 2007.

Some have speculated that the "doughnut hole" will be eliminated. So far, there has not been much evidence this is going to occur. Many of those enrolled in Plan D are saving approximately 50 percent on their medications. During the year, there was a study that showed 70 percent of participants were pleased with the program.

During 2006 we have witnessed the greatest change in Medicare since it began. There are as many as 45 million people directly affected by the Medicare Part C (Medicare Advantage) and Medicare Part D (prescription Insurance).

There are more choices for people on Medicare than ever. They should not be referred to as senior services, because there are those under 65 on Medicare due to disability. When enrollments for Plan D occurred for 2006, there was a great amount of confusion for those in Vernon County who were eligible. The confusion may continue for 2007. Education on this subject is important.

There were scammers out there during the previous enrollments and they will be back.

A marketer in Florida related that one of his agents talked to a person who had enrolled in Plan D. The agent who enrolled the person had not told about the "doughnut hole" -- an inapposite presentation. The beneficiary changed over to the plan the second agent was presenting.

The Annual Enrollment Period (AEP) will be from Nov. 15 to Dec. 31, for the prescription drug program. Those who did not enroll previously will have the opportunity during that time, which may include a penalty. A different Plan may be selected during this time by those currently enrolled in a Plan D which will become effective Jan. 1, 2007. Only one change may be made during the AEP. Once the change is made, it is locked in until the next annual enrollment period. Apparently what was considered some of the better plans previously may no longer be the best. You will find that many of the rates for premiums will be going up.

It is important to select a plan that will have the formularies that you need. The prescriptions that you take will determine which will be the best plan for you. It is a matter of making a comparison and then selecting the best plan for you.

Marketing for the Plan D to take effect Jan. 1, 2007, may have began You will be observing advertisements; however enrollment can not start until Nov. 15. You will then have until Dec. 31, for the enrollment.

Medicare Advantage Private Pay for Service was new in 2006. Enrollment in both Medicare Part A and Medicare Part B is necessary prior to enrolling in this program. Apparently those participating in this program are averaging about $100 per month savings. Those enrolled pay a small premium or none. There is confusion in that there are those who think it is not a part of Medicare, but it is. The company has a contract with the government and is paid so much for each one enrolled. The company then administers the program and pays the provider for the service. The person enrolled will pay a fee for the service received. It covers everything that original Medicare covers and has additional coverage.

The PFFS is not a Medicare Supplement. A Medicare Supplement cannot be used with a PFFS. It may or may not include a prescription drug card. There will be more options this year to enroll in a PFFS as more companies are getting involved with the program.

A PFFS is not for everyone. Many are better off with original Medicare and a Medicare supplement. It is the responsibility of the agent to educate the Medicare person and to provide what is of the best interest for the client, not what is of the greatest benefit for the agent.

The PDP and Medicare Advantage are administered by Centers for Medicare and Medicare Services. They have regulations that companies and agents have to follow. This includes door-to-door sales.

Remember, if someone calls you during this time, do not provide them any private information over the phone, including date of birth and Social Security number.

One person in Kansas saved about $100 a month by changing Medicare supplement companies. This person had to go under underwriting for this to be accomplished. In Missouri we have an open enrollment each year in Medicare supplements. Each year a person with a Medicare supplement can change companies, 30 days before or after the annual issue date. Rates are going up. It is best to shop.

There will be much publicized in a variety of ways for those who are on Medicare.