Guest opinion
Confused about Medicare Part D enrollment?
By Maria Cumsille Special to the Acorn

From now until Dec. 31, millions of individuals with Medicare A and B will be bombarded with enrollment mailings and TV and radio advertising about their choices for a Medicare drug benefit for 2008 called Medicare Part D.

The Medicare Part D program, enacted by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), began in January 2006 and is voluntary; however, late penalties may apply in certain situations.

An individual can enroll in Medicare Part D in one of two ways: Purchase a stand-alone prescription drug plan (PDPs) or a Medicare Advantage plan with a drug benefit.

Both Medicare Advantage and PDPs have the same annual $2,510 benefit for 2008, as well as the same coverage gap and catastrophic overage as standardized in the MMA. However, the delivery of plan benefits varies.

Every year, Medicare beneficiaries can choose to stay with their current plan or move to another plan that better suits their needs without medical underwriting.

Medicare has a low-income subsidy program featuring lower copayments for individuals who live on limited resources or are on Medi-Cal.

More than 56 plans are available to individuals in Ventura and Los Angeles counties, each having different costs and covering different formularies.

As the individual's drug use changes, it is very important that an annual analysis be performed. Here are some tips and terminology to help in the process:

•List all your current prescriptions with dosages and monthly quantities.

•Make an appointment with your trusted insurance agent who is certified to enroll you in at least four Medicare Part D plans; or, call your local senior center who has an HICAP advisor to assist you. You can also call Medicare at 1 (800)-medicare- preferably in the late afternoons- or go to the Medicare website at medicare.gov. Your local pharmacy has access to the Medicare website if you don't.

•Look at plans that have all your prescriptions on their formulary; otherwise, the uncovered drug cost will not be counted toward the true outof pocket expenses called TrOOP or catastrophic coverage. The effect will be to increase your overall cost.

•If you have a favorite pharmacist, look at their in-network pharmacy list. Many plans offer 90-day supplies at lower costs through their mail order service.

•Look to see if the plan has any restrictions. Many plans have prior authorization: requirements that the plan approve a formulary drug before the plan will cover the prescription; step therapy: requirement that certain medication(s) be tried before that prescribed by the individual's physician is approved; and, quantity limitations. By law, a "transition" process must be used for temporary use of drugs not covered by the plan; and, an "Exceptions" process in which the individual can appeal to have their drugs covered by the plan.

•If you find your current plan has the benefits that fit your usage, do nothing. You will be automatically enrolled for 2008. If you want to change plans, you can enroll through your agent- agents may receive a small enrollment fee of $50 or less)- online at the plan's website, or, medicare.gov or by calling Medicare.

Once completed, it is critical that you get an enrollment confirmation number as proof of enrollment.

Maria Cumsille is a certified financial planner who specializes only in insurance products and lives in Simi Valley. She conducts community service presentations on Medicare Part D and financial planning classes at UCLA. She can be reached at (805) 444-8889 or mariacfp@sbcglobal.net.