In past years, my October article always has been about the Medicare open season, more correctly titled, “Annual Election Period.” This year’s October article also will follow that same path and years 2012 and probably 2013 also will partially coincide with another open season.
I can hear you wondering, “How can you have two simultaneous open seasons?”
The answer is really quite simple. Each open season is for a different segment of the population.
Washington instituted a semi-annual open enrollment period for persons under the age of 19 to purchase health insurance. This period will run from Sept. 15-Oct. 31, so while not exactly on the scale of a lunar eclipse, we will have an overlap of open seasons for a two-week period.During this time frame a person under age 19 can purchase, either as an individual plan or on a parent’s plan, coverage on a guaranteed issue basis, meaning no health questions. Outside of these semi-annual open enrollment periods they are unable to obtain individual coverage unless they have an eligible reason for an exception.
Back to the Medicare open season. The biggest and most important change taking place is the change of the dates. Starting in 2011 and beyond, the Annual Election Period will be from Oct. 15-Dec. 7. Yes folks, the same Dec. 7 that will live in infamy according to the famous FDR speech of nearly 70 years ago.
This change makes it highly likely that if a person chooses to change Medicare coverage for either a Medicare Advantage Plan or a stand-alone Part D prescription drug plan, he or she will have new ID cards in hand prior to the Jan. 1 effective date and have a smooth transition from one plan to the other.
From my initial review of plan details that were released on Oct. 1, I think this could be a quiet year for plan changes. Most of the plan changes appear to be incremental and not drastic in scope.
In 2012, Washington will have choices of 30 different Part D prescription drug plans. This is down slightly from the 32 choices in 2011 and down drastically from the 50+ plans of the first couple of years of the program’s existence.
Of those 30 plans, 27 are continuing plans, with five plans having chosen to leave the marketplace and three new plans having entered.
Four of the five sponsors will have other plans available in the state and just will move clients to another of their options. The only plan that is leaving without a replacement is a plan offered by Rx America and co-branded with CVS (a large national drugstore chain with no Washington physical locations).
The three new plans for 2012 are from existing participants and we have no new players in the marketplace.
Of the 27 continuing plans, nine have lowered their premiums for 2012 and 18 have increased their premiums. The premium increases range from a very paltry 10 cents per month for the most expensive Humana plan, to an eye-staggering $31.20 for the Unicare Rx Rewards Plus plan. On the decrease side, the decreases ranged from $1 for the Silverscript Value to an impressive $25.80 for an offering from Aetna.
We have seen quite a lot of reshuffling and merging going on behind the scenes, so here are some of the ones that jump out to me.
Aetna has dropped the plan it had co-branded with Costco. Silverscript has purchased the Community Care CCRx product line from Universal American.
For 2012, Silverscript will be offering both product lines, but as of this date has not appointed any agents to represent the Community CCRx plans.
Silverscript has further expanded its branding efforts with the CVS drug stores. Envision Rx is now co-branding with Rite-Aid. We even are seeing more preferred pharmacy discounts than we knew about, so make sure you are using a preferred pharmacy in order to receive the biggest discounts you are eligible for.
One of the new plans that appears to be attractive is from First Health Part D. It is called the Premier Plus plan and has a monthly premium of $25.20 with a $0 deductible. It has a $0 co-pay for preferred generics at Walgreens and also Walmart, higher co-pays at other stores.
For example, a preferred generic would be $7 per month at other pharmacies. So, at first glance this plan appears to be far more attractive than the lower-priced Humana Walmart plan at $15.10 because it has a $0 deductible whereas the Humana plan has a $320 deductible.
I would strongly recommend that all readers do the following:
Check the formularies of your current plan or any other plan you may be interested in. I know it can be boring or tedious to read the fine print, but you better believe the old phrase, “The devil is in the details,” is definitely true with these plans.
By now everyone on a Medicare-sponsored program that includes drug benefits should have received an Annual Notice of Change package. Please take the time to review your benefits, premiums and far more importantly, the formulary to ensure your current medications will be covered for 2012.
The following are ways that you can obtain assistance to review your options for 2012. The easiest is to visit the wonderful website www.medicare.gov.
Enter all your pertinent information and it will miraculously prepare a report with plan options including premiums, co-pays and deductibles for all 30 plans available in Clallam County for 2012.
This same service is available 24/7 by calling those same folks at Medicare at 800-633-4227. Local help also is available in person by visiting the local Statewide Health Insurance Benefit Advisors (SHIBA) at 411 W. Washington St. or your local insurance agent.
Phil Castell can be reached at 683-9284 or PhilCastell@msn.com.
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