Focus on Epilepsy: Medicare (Fall 2006)

What You Need To Know For Open Enrollment

Drug coverage is essential to people with epilepsy. If you participate in Medicare, you may now receive coverage through a Medicare prescription drug plan.

If you are already enrolled in a Medicare drug plan, you should have received information from your plan about your continued coverage. If, for any reason, you are not satisfied with your coverage, you will soon have a chance to switch to a different Medicare drug plan for 2007. This Focus on Epilepsy: Medicare fact sheet provides important information about this opportunity.

Open Enrollment

You may be satisfied with the drug coverage you already have.

If so, you do not need to change anything.

You should check your current plan to see if coverage for your drugs has changed. If after checking, you are still satisfied with your current plan, you do not need to change anything. But if you believe your drug plan will not meet your needs in 2007, then between November 15 and December 31, 2006, you may switch to a plan that better meets your needs. This period of time is called Open Enrollment.

Dual eligibles

For most people with Medicare, this Open Enrollment period will be the last opportunity to request a new plan before November 15, 2007. However, if you are a "dual eligible" who qualifies for both Medicare and Medicaid, then you may change your drug plan any time, but be sure to keep in mind that the new plan coverage will go into effect the first of the month after you switch plans.

A Shorter Enrollment Period

Last year, Medicare's Open Enrollment ran from November 15, 2005, to May 15, 2006. But beginning this year, Open Enrollment will be shorter, starting on November 15, and ending on December 31, 2006. It is important to remember that if you choose a new plan during Open Enrollment, that plan will begin covering you on January 1, 2007.

Act Early

Although Open Enrollment lasts until December 31, 2006, it is a good idea to enroll in your new plan by December 8, 2006. This will give Medicare time to process your change and will reduce your chances of standing in lines, experiencing problems at your pharmacy, or having any gaps in your coverage when your new coverage begins January 1, 2007.

A Variety of Choices

By now you should have received your updated 2007 Medicare & You handbook. Consult the handbook for information about plans offered in your area. You may find new options, some with lower costs or coverage of more drugs.

Nationwide, plans are covering 13% more drugs than they did in 2006. Plans also offer important preventive benefits, such as flu and pneumococcal shots.

Extra Help: The Low-Income Subsidy

Extra Help

Getting "extra help" with your prescription drug coverage means Medicare will help pay your premiums, deductible, and co-pays.

Who Qualifies?

You might think that you are not eligible for extra help. As of June 2006, more than 9 million people with Medicare were able to obtain additional help. Most of these people were automatically eligible because of other programs for which they qualify. But, almost two million people had to apply for extra help in order to receive it. If, for financial reasons, you believe that you might qualify for extra help, you should fill out an application to help determine if you are eligible.

If Your Status Is Changing

If you qualified automatically in 2006 but you have received a notice that you are not automatically qualified in 2007, you may still be entitled to receive this benefit. You should fill out an application to help determine if you are eligible. Follow Medicare's advice: "If in doubt, fill it out!" How to apply for extra help. To apply, visit www.socialsecurity.gov, call 1-800-772-1213 (for TTY users, 1-800-325-0778), or consult your local Social Security office. Your state Medicaid office will be able to help you as well.

To find the number of this office, you can call 1-800-MEDICARE [1-800-633-4227] (for TTY users, 1-877-486-2048) or consult www.medicare.gov.

If you don't qualify. Even if you do not qualify for extra help, you may still be able to lower your prescription drug costs by using the Open Enrollment period to switch to a less expensive plan. Some 2007 prescription drug plans charge no premiums or deductibles. But before you switch to such a plan, be sure to compare the new plan you are considering to your current plan to determine if you will save money and to confirm that you will still be covered for the medications you need. If it is important to you to use a particular pharmacy, check whether the new plan will permit you to do so. If you have limited income and resources, but think you may still qualify for extra help, then you should apply as soon as possible. If you apply and qualify, you will continue to get extra help in 2007. An application for extra help will be mailed with your notice, and you should fill it out and mail it back to Social Security as soon as possible.

Evaluating Your Plan

Comparing Plans: The Basics

Before you use the Open Enrollment period to change your drug plan, it is important to compare your options carefully. Ask yourself the following questions:

• Did I compare plans based on benefit structure?
• What will my premiums and other out-of pocket costs be under each plan?
  Be sure to consider whether your costs will change in 2007 if you keep your existing plan.
• What medications will I be taking in 2007, and will the plans I am considering cover them?
• Am I satisfied with the service I receive from my existing plan? (e.g. appeals process or access to plan customer service representatives)

Comparing Plans: The Doughnut Hole

Under some Medicare drug plans, after you have spent a certain amount of money and/or received a certain level of benefits, your coverage changes and you are responsible for all costs for your drugs up to a certain level. However, if you go on to pay more than $3,600 for drugs in a single year, you qualify for catastrophic protection, and almost all of your additional costs will then be covered. This "gap" (the period in which you are responsible for drug costs) is sometimes called the "doughnut hole." As you evaluate various plans and decide which one is best for you, it is wise to consider whether the plans that interest you offer the extra benefit of providing coverage for you during the doughnut hole.

Certain Drugs for Epilepsy May Not Be Covered

If your doctor has prescribed barbiturates or benzodiazepines for you it is important to note that most plans do not cover these medications. However, starting in January 2007, some plans are covering these medications on their own, outside of the Medicare prescription drug benefit, so it is worthwhile to check with the plans on their coverage of these medications. When you compare and evaluate drug plans during the Open Enrollment period, it is essential that you determine how the plans you are considering cover your epilepsy medications.

If your physician has prescribed these medications and your plan does not cover them, then you may want to contact your state Medicaid program to determine if they cover these medications.

Resources That Can Help

Many resources, including the following, are available during the Open Enrollment period to help you compare Medicare prescription drug plans and choose one that is right for you:

The Medicare Prescription Drug Finder

The Finder can identify plans available in your area, compare their cost, coverage and service, and help you select one that meets your needs. This tool is available at www.medicare.gov.

RxCompare

Medicare Access for Patients-Rx (MAPRx) is a coalition of healthcare organizations, including the Epilepsy Foundation, that represents patients, families, caregivers, and provider organizations. MAPRx also offers RxCompare, a tool to help people with Medicare compare prescription drug plans. You can find RxCompare at www.maprx.info.

MedicareRx Connect

This service provides links to information about how Medicare covers drugs for specific diseases, including epilepsy. It is also available at the MAPRx website, www.maprx.info.

Partnership for Prescription Assistance Program (PPA)

PPA is a joint effort by drug companies, healthcare providers, patient-advocacy groups, and community groups. Its purpose is to help patients who do not have drug coverage find a public or private program that can get them the medicines they need. It also helps qualified Americans enroll for drug coverage through Medicare. More information is available online at www.pparx.org or by calling 1-888-4PPA-NOW (1-888-477-2669).

Formulary Finder for Prescription Drug Plans

This tool will allow you to find plans in your state that match your required drug list. It is available at http://formularyfinder.medicare.gov/formularyfinder/selectstate.asp.