Блог Анкара

In This Chapter

^ Recognizing when you can enroll in Part D without incurring a late penalty

^ Confirming some last-minute items before signing up

^ Understanding the process of enrolling in a Medicare drug plan

^ Figuring out why your enrollment may be held up or rejected

#«^hew! The hard part’s over. You’ve chosen a Part D plan — either a

Stand-alone drug plan or a Medicare health plan that comes with drug coverage. In contrast, signing up for that plan’s usually a cakewalk.

In this chapter, I assume you’re joining Medicare Part D for the first time. Even so, people may be plunging into the Part D pool from a number of points, so I consider these different circumstances in explaining when to enroll in a plan. Then I suggest some last-minute checks you can — and should — make Before Signing up. After that (at last!), I show you how to enroll and give you some tips on the process. Finally, I explain how an enrollment application may occasionally be delayed or denied.

Stay Informed: Knowing the Right Time to Enroll

The right time to enroll in Part D is when you can sign up without incurring a Late penalty — extra payments that add to your premiums for as long as you stay in the program. In Table 12-1, the white area shows when you can enroll in Part D for the first time to avoid a late penalty. The shaded area shows when you can sign up if you delay and miss these deadlines, or deliberately drop your current drug coverage — in which case you should probably prepare to face a late penalty.

In the following sections, I describe the three kinds of enrollment periods in Table 12-1 in more detail and explain why you shouldn’t wait until the last minute to enroll in a Part D plan. For the full scoop on how you can avoid the late penalty, head to Chapter 8.

Distinguishing among different enrollment periods

Medicare permits three types of enrollment periods:

Initial enrollment period (IEP): Medicare assigns you a seven-month IEP around the time of your 65th birthday or, if you’re younger and have a disability, around the time you receive your 25th Supplemental Security Income (SSI) check. You can use this time frame to sign up for Medicare Parts A and B, according to your circumstances, as explained in Chapter 1. You can also sign up at this time for a Part D plan if you don’t have Creditable drug coverage. Basically, this term means drug coverage from elsewhere (like an employer or union) that’s considered at least as good as Part D. (Still baffled? Take a look at Chapter 6, which covers creditable drug coverage in detail.) If you lived abroad or were in prison at the time of your 65th birthday, you get a special IEP, also lasting seven months, to sign up for Part D upon your return to the U. S. or upon your release, as explained in Chapter 8.

Special enrollment period (SEP): Medicare allows you an SEP to join Part D in certain circumstances — if you lose creditable drug coverage through no fault of your own or have an unavoidable break in coverage. You get an SEP if your employer terminates your drug benefits or reduces coverage so it’s no longer creditable. You also receive an SEP if you turned 65 before moving abroad or going to prison and want Part D coverage after your return or release.

If you’re eligible for an SEP, all you have to do is sign up with your chosen Part D plan and make sure that your coverage starts within the allotted time. You Don’t Have to apply for an SEP in any of the circumstances shown in Table 12-1.

Annual enrollment period (AEP): If you don’t have creditable coverage and fail to sign up for a Part D plan before your IEP or SEP expires, you can’t sign up for a plan until the next AEP that starts November 15 and ends December 31. As a result, you’ll be without drug coverage until January 1 and will face a late penalty. Also, if you deliberately dropped creditable drug coverage (instead of losing it involuntarily), you can sign up for Part D only during an AEP.

If you qualify for low-cost drug coverage under Part D’s Extra Help program (see Chapter 5), you can enroll in a Part D plan any time you want during the year. Your coverage starts on the first day of the month after you enroll. You won’t incur a late penalty, even if you sign up late.

Recognizing why you shouldn’t sign up at the last minute

Your Medicare prescription drug coverage begins on the first day of the month after you enroll in a plan. Technically, you can sign up on the very last day of an initial or annual enrollment period (for example, December 31) and still be covered the next day (in this case, January 1).

But — and this is an alert for the chronic procrastinators — putting off enrolling until the last minute isn’t the best idea. In fact, Medicare recommends signing up at least two weeks before your deadline. Here’s why:

I The plan needs time to verify the information you provide on the

Enrollment form (such as your eligibility to receive drug coverage) or to get back to you if the information is incomplete (see the later section "If your enrollment is delayed" for more).

I You want to be able to mosey over to the pharmacy and pick up your meds without hassle after your Medicare drug coverage begins. Giving your Part D plan enough time to upload your data into the computer system increases the odds of this process going smoothly. (Flip to Chapter 14 for the basics on filling your prescriptions.)

I If you have a special enrollment period, you must receive Part D coverage before the 63 days are up to avoid a late penalty. If you wait longer than 60 days to enroll, you can incur a penalty, depending on where your SEP falls in the calendar, as explained in more detail in

Chapter 8.

I Here is a different reason for signing up as early as you can: If you have a seven-month IEP and enroll in a Part D plan during the First three months Of that period, your coverage starts on the first day of the month in which you turn 65 or in which you become eligible through disability — even if those dates fall at the end of the month.

Play It Safe: Making a Few Final Checks before You Sign Up

Yes, I know — you’ve had enough of all this rigmarole by now and just want to join the darned plan! I sympathize. But remember that after you’re enrolled, you’ll probably be locked into the plan for the whole year. So I don’t feel comfortable saying, "Okay, go ahead," without suggesting a few practical, final precautions. Following them is entirely up to you, of course, but playing it safe never hurts, and sometimes it pays off big-time.

Make sure you live in the plan’s service area. If you live outside this area, your enrollment won’t be accepted.

Keep the plan details as a record of why you chose the plan. If you

Chose it from the online Medicare Prescription Drug Plan Finder, print out all the details that show your likely costs and keep them safe. If you called the Medicare help line for the same information, keep the printout the customer rep sent you. You need this record if, after enrollment, you believe the plan’s charging more for your drugs than it quoted on the plan finder and you want to change to another plan as a result, as explained in Chapter 17.

Double-check the details of your costs under the plan. Make sure the drug information you entered into the plan finder is correct, as I describe in Chapter 10. If the details you entered — especially each drug’s dosage and how often you take it — aren’t accurate, the quoted costs aren’t going to be accurate either. Verify your likely costs by looking at your printout and/or calling the plan.

I Make sure that this plan is the one you want and that you understand its conditions. This check is especially important if you chose this plan on the advice of a salesperson or insurance agent, or from marketing materials sent through the mail. If you’re not sure this plan is "the one," call it — not the salesperson — to confirm you understand exactly what you’re buying. When people are misled into joining an inappropriate plan, it’s often because they didn’t fully understand the plan’s conditions and consequences, as explained in Chapter 11.

If the plan is a Medicare HMO or PPO, make sure it includes drug coverage. If you join an HMO or PPO that doesn’t cover drugs, you won’t be able to get drug coverage any other way for the rest of the year, as I describe in Chapter 9.

If the plan is a Private Fee-for-Service plan or a Medicare Cost plan, confirm that it includes drug coverage. If it doesn’t, and you want drug coverage, you should choose and enroll in a stand-alone Part D plan before your enrollment period expires. The same is true of Medicare Medical Savings Account plans, which don’t cover drugs.

If you chose your plan through a search of Medicare’s online plan finder, you won’t have to verify whether the plan is in your service area or includes drug coverage. Because you must enter your zip code at the beginning of this search, all the plans that appear on-screen are available in your area, and all of them cover prescription drugs. Otherwise, you can call Medicare at 800-6334227 to check these details.

Take the Plunge: Enrolling in a Plan

Actually enrolling in a plan is the easy bit. You still have choices on how to do it, but they’re simple ones. The process is the same whether you’re enrolling in a stand-alone prescription drug plan (PDP) or a Medicare health plan that includes drug coverage (MAPD). All you need are your Medicare ID number and the name of the plan you want to join. Then you can sign up, or a legal representative can do so on your behalf, in any of the following ways:

W Calling Medicare’s help line toll-free at 800-633-4227: Tell the customer representative you want to enroll in a Part D plan. Have at hand your Medicare ID number and the name of the plan.

W Visiting Medicare’s Web site at Www. medicare. gov: On the home page, look for a menu headed Prescription Drug Plans in the top right-hand corner and click "Enroll." Doing so takes you to the Medicare Part D enrollment center. Most plans allow enrollment through the center, but a few may not. If your chosen plan doesn’t, the customer representative at the center can give you that plan’s phone number.

I Calling the plan directly: You can find the plan’s customer service number in its marketing materials, on its Web site, or on the top right of its plan details page (if you chose the plan on Medicare’s plan finder or asked Medicare to mail you details of the plan).

I Visiting the plan’s Web site: If the plan offers online enrollment (not all do), you can find its Web site address in its marketing materials and on the top right of its plan details page on Medicare’s online plan finder. Or you can do an Internet search for the plan’s name.

I Completing a paper application: Call the plan and ask it to send you an application. Fill out this paperwork, sign it, then mail or fax it to the address or number provided.

And that’s it! Well, almost. Whichever way you choose to sign up, you’ll be asked a number of questions you must answer before your enrollment can be completed. Be prepared by having this info ready:

I Your name, address, and phone number

I Details of your Medicare coverage, as shown on your Medicare ID card

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I Details of any other drug coverage you may have

I Circumstances indicating that you may qualify for Extra Help

I How you want to pay your premiums

I If you live in a long-term care facility, such as a nursing home

A Part D plan can’t ask you for your bank account or credit card information during the enrollment process, regardless of whether you enroll on a paper form, by phone, or online.

Enrollment is a legal contract between you and the plan. So if you can’t manage the enrollment process yourself, either through incapacity or illiteracy, the person who enrolls you must be someone who has the authority to do so under your state law. This person can be a legal representative, a court-appointed guardian, or a family member or caregiver who has Durable power of attorney — that is, someone authorized to make medical decisions on your behalf. When making the enrollment request — whether on paper, online, or on the phone — your representative must attest that she has the appropriate legal authority and can show documentary proof if the plan requests it. She must also provide her contact information.

In the following sections, I tackle in detail three important issues that may arise during the enrollment process.

Grasping the importance of your address

No, your Medicare prescription drug plan doesn’t care a scrap whether you live in a mansion or a minivan. But the address you provide determines

I If you live in the plan’s service area: No plan will accept your enrollment if you don’t live in its service area. For stand-alone drug plans, that means living in the state the plan serves. For Medicare health plans, this area is defined as the region (a state, county, or zip code) that the plan serves. Even for plans that don’t have defined service areas, you must sign up for the one that’s offered in the area where you live.

I Where your permanent residence is: You can’t be enrolled in two plans at the same time, so if you live in different states during the year, you can’t have one plan per address. When enrolling in a plan, you must give the address of your Permanent Or Primary residence — the place considered to be your normal home (for example, the one used on tax forms). If you provide a post office (PO) box number as your address, the plan must contact you to confirm that you live in its service area.

If you’re homeless or don’t have a fixed address, the Part D plan you want may accept the address of a shelter or clinic, a PO box number, or anywhere else that you receive mail.

Deciding how to pay the premiums

When enrolling, you’ll be asked how you want to pay your monthly premiums to the plan. Here are your options:

I Ask the plan to bill you directly and pay the premiums every month by check, money order, or credit card.

W Have the premiums deducted automatically from your monthly Social Security checks. (The plan arranges this deduction for you.)

I Agree for the premiums to be automatically sent to the plan each month by Electronic Funds Transfer from your bank, or charged to your credit card. (The plan will ask you to fill out and return a form, along with a voided check from your bank account or your credit card details.)

Many people choose to have their plan premiums taken out of their Social Security checks, in the same way that Medicare Part B premiums are deducted. But this payment method can cause difficulties. There have been many instances of Social Security failing to make plan premium deductions for the first two or three months, and then taking them all out of a single check. Or, in the case of people who’ve switched from one plan to another, deducting two premiums rather than one for several months. Similar errors can occur in automatic payments from a bank account or credit card.

Disclosing other drug coverage you have

During the enrollment process, you’ll be asked whether you have any other drug coverage — for example, coverage from an employer or union, veterans or military benefits, private individual insurance, or a State Pharmacy Assistance Program (SPAP). The Part D plan needs this info for two main reasons:

W To protect you: In some cases, joining a Part D plan can automatically cancel your other medical and drug coverage, as explained in Chapter 6. If you have creditable drug coverage from elsewhere, the plan may contact you to confirm that you understand the consequences of joining Part D. You’ll have 30 days to respond. If you don’t respond within this time frame, your enrollment will be denied, as I explain later in this chapter.

W To coordinate your benefits properly: Listing any other benefits you’re entitled to means that the plan can log them into its computer system so that when you go to fill your prescriptions, the pharmacist knows what to charge you and whom to bill. Otherwise, you may pay more than you should. I explain more about how this coordination of benefits works (and how it sometimes doesn’t) in Chapter 14.

Don’t Give Up: Understanding Why Your Enrollment May Be Delayed or Denied

Your enrollment isn’t complete until your chosen plan accepts it. Within ten calendar days of receiving your enrollment request, the plan must send you one of these items:

W A notice acknowledging your completed application, together with a copy of it, and details about the plan’s costs, benefits, and conditions

W A request asking for more information to complete the application

W A notice saying your application has been denied

If you receive only the acknowledgment, your enrollment probably will be confirmed very soon, and you’ll receive your membership card and Evidence of Coverage, as explained in Chapter 13. Read the following sections if your plan sends you either a request for more information or a denial notice.

If your enrollment is delayed

Enrollment can be delayed if

W You haven’t completed all the information required on the enrollment form, and the plan needs to get back to you

W You don’t submit additional information as soon as you’re asked

W Medicare doesn’t immediately confirm that you’re eligible

W The plan discovers you have coverage from elsewhere (such as employer or union health benefits) and contacts you to be sure you understand the consequences of joining the plan

IJ$jAB££ In all of these cases, the plan will contact you either by mail or phone. So it’s important to look out for a letter from your plan, or to return messages it has left on your answering machine. If you’re asked for more information and don’t provide it within 30 days, the plan has no choice but to consider your application incomplete and reject it.

What if your enrollment’s delayed past the date when your coverage should begin? In this situation, the plan covers you until the matter is resolved. (During this time, you can use a copy of your enrollment form or the plan’s acknowledgment as proof of coverage at the pharmacy until your plan membership card arrives, as explained in Chapter 13.) But if your enrollment is ultimately denied for any of the reasons in the next section, you’d have to repay the plan for any services used.

If your enrollment is denied

If you’re in Medicare, you have an absolute right to Part D coverage. So if a plan turns you down, you need to know why. Here are the possibilities:

W Your eligibility for Medicare can’t be found in the official records.

W You didn’t answer all the questions on your enrollment application, didn’t complete it within the required time, or failed to respond to the plan’s request for additional information.

W You don’t live within the plan’s service area.

W Your enrollment period has expired.

W You applied outside the time frames for initial or annual enrollment, and you don’t qualify for a special enrollment period.

W You have creditable drug coverage from an employer or union, and you didn’t respond within 30 days to the plan’s request for confirmation that you understand how joining Part D can affect this coverage.

W You’ve applied to a Medicare Advantage plan but don’t have Medicare Part A and Part B. (Both are required for MA plans. To join a stand-alone Part D plan, you need only one or the other. To join a Medicare Cost plan, you need only Part B.)

W You’ve applied to a Medicare Advantage plan but already have end-stage renal disease. (ESRD patients can’t join an MA plan.)

W You’ve applied to a Medicare Advantage plan that isn’t currently accepting new enrollees.

W You’ve applied to a Special Needs Plan but don’t fall within the category of people it serves, as explained in Chapter 9.

W You’ve applied for a Medicare Medical Savings Account plan but don’t meet its eligibility requirements, as explained in Chapter 9.

If your enrollment’s denied, the Part D plan or Medicare must send you a letter explaining why. You don’t have the right to appeal against an enrollment denial. But if you think the given reasons are incorrect, call the number on your denial notice as soon as possible. Provide information showing why you think the denial is incorrect. If that doesn’t work, contact your regional Medicare office to explain the problem. (For the office number, call Medicare at 800-633-4227.) You can also get expert advice and help from your State Health Insurance Assistance Program (SHIP) or the Medicare Rights Center; see Appendix B for contact info.

Part IV