To our readers: The holidays are coming, but the Open Enrollment Period (a.k.a. the Annual Election Period) for seniors covered under the new Medicare Prescription Drug Benefit Plan – also known as Part D – is already here.

Extending only from November 15th through December 31st, the brief enrollment period gives seniors a small window of opportunity to join a plan, switch from one plan to another, or drop their plans. No matter the choice, once done, no changes can be made until the next enrollment period a year from now.

According to the National Mental Health Association (NMHA), as the controversial Medicare Drug Benefit Plan prepares to observe its first anniversary, “many changes have been made affecting the treatments beneficiaries can access, cost-sharing, and other policies”.

So we’d like to use this NextSteps column to remind seniors, their families, and their caregivers about the December 31st deadline, and to recap how seniors can ensure they are enrolled in the plan that best suits their needs. New coverage takes effect on Jan. 1, 2007.

First of all, if you are satisfied with your current prescription drug plan (PDP) and decide it will meet your needs in the coming year, there is no need to re-enroll, and your coverage will continue without interruption. However, seniors should still compare the costs and benefits of other plans in their area, because there may be more options that cost less and offer additional coverage.

It is also important to review your plan annually because, each year, details about your PDP may change -- including what drugs are covered. “What may have been a good plan for someone in 2006 could be entirely different in 2007,” says NMHA president and CEO David Shern. “It’s important that [Medicare] beneficiaries educate themselves about all their options by choosing the plan they determine best matches their needs.”

If you are not happy with your current coverage or decide that your plan won’t meet your needs in 2007, compare the costs and formularies (i.e., the list of covered prescription drugs) of PDPs in your area. After you determine which plan is best for you, you can enroll in that plan by going to www.medicare.gov or click here, or by calling 1-800-MEDICARE, or contacting the PDP directly.

Here are some important questions to ask that will help you determine if your plan will meet your needs in the coming year, says NMHA:
• Will my deductible, premium, or co-payments increase?
• Will all my prescriptions still be covered?
• Will there be new restrictions (prior authorization, step-therapy, etc.) on my prescriptions?
• Will my pharmacy still be in the plan network?
• Have I been happy with the plan’s customer service?

After answering these questions, you may decide to switch to another PDP. Remember: You must do so by December 31st, but be sure not to drop your current PDP until you identify your new plan.

Other important details:
• If you can’t afford your plan’s out-of-pocket costs, you can apply for Extra Help, also known as low-income subsidy (LIS). If you qualify, the government will pay many of the costs of the Part D program, including premiums, deductibles, and co-payments. To determine your eligibility and to apply online for Extra Help, visit www.BenefitsCheckUp.org or click here. To apply by phone, to request a paper application, or to make an appointment at your local Social Security office, call 1-800-772-1213. There are a variety of other state, community, and private assistance programs that may offer financial help when paying out-of-pocket costs for your prescription drugs. The Web site just mentioned can provide more information on these resources, as can your local Social Security office.
• Experts say it is best to enroll in any new plan by December 8th so you can have your prescription drug card and get the prescriptions you need on January 1st.
• If your income level has changed and/or you no longer qualify for Medicare and Medicaid, belong to a Medicare Savings program, or receive Supplemental Security Income (SSI), you may not automatically qualify for Medicare Prescription Drug Coverage. You may have to enroll in a new plan.


If you think all of this is incredibly complex, you’re right. Perhaps the new Congress that convenes in January will consider some needed changes their defeated counterparts have ignored. For more information about this topic, go to the NMHA Website at www.nmha.org/medicare or click here.