November Newsletter 2008

Don't Make a Mistake During Annual Enrollment

The annual enrollment period for your Medicare Part D benefits starts November 15th. Read the top ten tips that will help you avoid costly mistakes during the annual enrollment period.

1. Don’t assume the best plan for you last year is the best plan for you this year. Prices and coverage changes from year to year
2. Use PlanPrescriber’s free tools to compare plans premiums, deductible, and coverage of the medications you are taking. Comparison shopping is one of the best ways to avoid enrolling in inadequate or too costly coverage
3. Enroll BEFORE January 1st. Missing the December 31st enrollment deadline will force you to wait until next year's annual enrollment period. Consequently, your coverage will be delayed and you will likely have to pay a penalty of an extra 1 percent on your monthly premium for coverage for the rest of your life.
4. Avoid common mistakes on your application form. Mistakes on an application form can result in delayed coverage. One of the more prevalent mistakes is illegible handwriting. If you have hard-to-read handwriting, you can have an insurance agent enter information on the application. Another common mistake is using the wrong year’s application form. Currently you need the application form for 2009 coverage. Using a post office box as a mailing address is also unacceptable on a Medicare Part D application so e sure to enter the address for your residence. You also must make certain that the name you enter on the application matches the name of your Medicare card exactly or the application will be rejected.
5. If you change plans during the annual enrollment period, you do not have to notify your existing Medicare Part D plan that you dis-enrolled.

For more assistance with Medicare Part D plan enrollment as well as plan comparisons, visit www.PlanPrescriber.com.

What To Do If You Have a Problem with a Medicare Part D Insurer

Prescription drug plans and Medicare Part D plans help millions of seniors with the costs of medications and healthcare. However, occasionally a senior may disagree with a coverage decision by the insurer. Some of the more typical disagreements between a senior and an insurer are:

1. The insurer does not cover a particular drug prescribed to the senior
2. The insurer will not cover the drug prescribed by a senior unless the doctor submits a formal request to the insurer which the insurer must approve
3. A drug is covered by the insurer by the maximum quantity covered per month is less than what is prescribed to the senior
4. The insurer insists that several inexpensive drugs must be used and proven ineffective for treatment before an expensive drug is approved
5. A plan discontinued coverage of a specific drug

Luckily, a senior has the right to appeal any decision about your Medicare services whether the decision was made by the Original Medicare Plan, a Medicare Advantage plan, or a Medicare prescription drug plan. When you enroll in a prescription drug plan, the insurer will send you information about the plan's appeal procedures (how to file responses, etc.). If you lost this information, you may call the plan’s customer service number and request the appeal information be sent to you.

An appeal of a prescription drug plan decision must be made within 60 calendar days from the date of the coverage determination, though this time period may be extended if you demonstrate a reasonable cause for a late appeal. If you submit a standard appeal, the insurer must respond to you within 7 calendar days. If your health could be seriously harmed by waiting 7 calendar days for a decision, you or your doctor can request a fast appeal. If the fast appeal request is approved by the insurer, the insurer must answer you within 72 hours.

If the insurer rejects the appeal (i.e. will not change its original coverage decision), you can appeal the insurer's decision to a 3rd party organization that works for Medicare. See your insurer's membership materials for more information or call Medicare directly.

Comparing insurance options and matching plans with your drug coverage reduces your chances (but does not eliminate them) for disputes with insurer coverage decisions. Visit www.PlanPrescriber.com to find the plan best suited to your circumstances.