Friday, October 14, 2011

Medicare Part D Open Enrollment Starts Tomorrow!

This year the Medicare Part D Prescription Drug open enrollment period starts and ends early, and is one week longer than it has been since it began in 2006. Open enrollment in 2011 is from October 15 through December 7 and your new plan election coverage will begin January 1, 2012.

Open enrollment is the annual period during which Medicare beneficiaries can choose to change to a new prescription drug plan or enroll in a plan for the first time if they have been eligible to enroll previously but chose not to. Unlike Medicare Parts A and B there is no public option for prescription drug coverage, you must choose from the numerous private prescription drug plans available under Part D.

By "numerous" I mean 36 plans available for West Virginians (and Pennsylvanians, who are also in our prescription drug plan region). This is a substantial decrease from the first years when over 80 plans were available, but a small decrease from last year, when we had 38 plans from which to choose. Half those plans this year have $0 deductible. The lowest premium is $15.10, the highest is $115.60. Two-thirds of the available plans in WV still have a donut hole (a point where you have no coverage at all after reaching a certain out-of-pocket outlay for the year).

Overall nationwide plan formularies (lists of covered drugs) seem to have largely stabilized, unlike the significant reductions in coverages we saw over the first several years of Part D. There have also been few changes regarding restrictions to coverage (for example requirements that the patient first try a cheaper drug before getting approved for coverage for a more expensive drug) this year compared to last year.

Low-income subsidies (commonly referred to as "LIS" or "Extra Help") are still available for those who qualify according to income and assets. LIS can cover premiums, deductibles, co-pays, and eliminate coverage gaps, depending on which subsidy you qualify for. Some beneficiaries are automatically qualified and enrolled in LIS, including those who are also beneficiaries of some form of Medicaid including QMB, SLMB and others. People who do not already receive Medicaid may still be eligible for LIS but may have to apply to be enrolled.

Any beneficiary who receives a notice about Medicare Part D extra help, especially a letter that is on colored paper, may have his or her benefits reduced or terminated if he or she does not respond.

Overall most Medicaid beneficiaries will benefit from the earlier and slightly longer open enrollment period, the stabilizing of plan options, formularies, and gap coverage, and the relatively low increase in average premiums this year.

As always the only practical way to compare and determine which plan is best for you is to use the Planfinder on The best source of assistance for West Virginians in choosing a plan, understanding a notice about Medicare benefits, or solving a problem related to Medicare Part D coverage is your local SHIP counselor who is housed in your county senior program. You can get contact information for your SHIP counselor at


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