Open enrollment for Medicare Part D Prescription Drug Coverage is Nov. 15 - Dec. 31, 2008, making this a good time to review your coverage. Before selecting a prescription drug plan (PDP) or changing your coverage, consider the following information to help you sort out your insurance options.

Q: What are Medicare prescription drug plans?

A: In 2003, the federal government enacted a Medicare prescription drug benefit for Medicare beneficiaries. Private insurance companies sell Medicare Prescription Drug Plans (PDPs) or Medicare Advantage plans approved by Medicare. Everyone with Medicare is eligible to enroll in Medicare prescription drug coverage, regardless of income or assets, and coverage is voluntary.

Q: What if I am already enrolled in a Medicare prescription drug plan?

A: Plan features might change from year to year. So, carefully examine all available plans during each annual enrollment period, because your current plan may no longer best meet your needs. Be sure to check the features of your plan, including the list of drugs covered, the premium, deductible, and cost-sharing you pay, and any coverage gap. If you are satisfied with your current plan, you do not need to do anything to keep your plan. If you take no action, you will remain in your current plan. If you enroll in or make changes to your plan during the annual enrollment period, your new coverage automatically begins Jan. 1, 2009.

Q: What if I am enrolled in a Medicare Advantage Plan with prescription drug coverage?

A: Medicare Advantage plans might also make changes to important features of your plan from year to year, including the list of drugs covered, the premium you pay, deductibles and cost-sharing requirements, and provider networks. Carefully review your plan options during each open enrollment season. If you take no action, you will automatically remain in your current plan.

Q: What if I already have prescription drug coverage?

A: A Medicare prescription drug plan might provide more coverage than a Medicare supplement insurance (Medigap) policy or employer-provided prescription drug coverage that you may currently have. If Medicare considers your existing coverage to be “creditable” – meaning coverage that is as good as the standard Medicare prescription drug coverage benefit – you are permitted to keep your current coverage without incurring future penalties. Check with your employer or Medigap plan before dropping an employer-provided prescription drug coverage or Medigap plan, because you may not be able to get it back. If you do not enroll in a Medicare drug plan when you are first eligible for Medicare, and you don’t have other creditable prescription drug coverage, you may be subject to a penalty if you decide to enroll at a later time.

Q: What are my options if I want to enroll in a Medicare prescription drug plan?

A: You can enroll in a stand-alone prescription drug plan (Medicare Part D) or you can choose a Medicare Advantage plan (Medicare Part C) that includes a drug benefit. Compare plans and select the one that best meets your individual needs annually. Here are a few things to consider:

See if all of your prescriptions are on the plan’s list of drugs (called a formulary).

Check to see if your preferred pharmacy is on the list.

Find out what co-payments you will be responsible for paying when filling a prescription.

Are the premium, deductible, and cost-sharing requirements for your preferred plan affordable?

Is there a coverage gap where you are responsible for all of the costs, and is this affordable?

If it is a Medicare Advantage plan, what are the network rules and will your current providers be covered?

How does enrollment in the new plan impact coverage you may already have (including employer-sponsored prescription drug coverage or a Medigap plan) or your enrollment in traditional Medicare?

Please send your insurance questions to:

Insurance Commissioner John Oxendine
716 West Tower
2 Martin Luther King Jr. Drive
Atlanta, Georgia 30334

Or call 404-656-2070 (toll free at 1-800-656-2298), from 8 a.m. to 7 p.m. weekdays, for assistance with an insurance question.

www.gainsurance.org