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Medicare Enrollment Deadline Approaching

By Jeralyn, Section Off Topic
Posted on Mon May 08, 2006 at 04:51:03 PM EST
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May 15 is the final day to sign up for Medicare drug enrollment. The article lists four primary groups of people who have not enrolled:

At the top of the list are those who have no drug expenses now. "They don't think they need a plan. But that's not right. You should enroll so you preserve your options for the future," he said. "The second group just thinks it's for low-income citizens. That's not true either," he said. Procrastinators make up the third group. Finally, some people just do not want to sign up for a government program, he said.

Unless I'm totally missing something, and I hope I'm not because I have not signed up my mother for the plan, there is another group for whom it does not make sense to sign up: Those with health insurance that pays prescription drug benefits. So long as the insurance company has sent you a letter saying that your current plan provides equal or better benefits than Medicare (called "creditable coverage"), there is no reason for you to enroll. The letter will be sent annually, and if the coverage goes below Medicare levels, you will be able to enroll in Medicare at that time without paying higher premiums for late enrollment. Here's the pertinent paragraph:

However, Medicare D is not for everyone. Like you, some retirees received prescription drug benefits through a company-sponsored retiree medical plan where they receive better coverage. So, even though you have a choice to enroll in Part D, you don't have to if you are getting better benefits from another source. As described below, your XXX retiree medical plan does provide you with better benefits than Medicare Part D's Standard Plan, at least for next year.

People who enroll in Medicare lose thier drug coverage under their private insurance plan, since duplication is not allowed.

The federal goverment pays a subsidy to the private insurer since they and not the Government are paying for the prescription drug benefit for the insured. Thus, it is in the employer-insurer's best interest to continue providing medical and prescription benefits.

Also, those who do not sign up for Medicare Part D will still be covered for drugs under Part B, such as drugs administered in a doctor's office.

This is all so confusing. I worry about the elderly who don't have anyone to make the calls for them to find out what they should do. And, there's always the chance that Medicare might be better for my mother and I'm just getting spin from her insurer who wants to keep her business.

Have any of you been dealing with making these decisions for parents or others unable to make them for themselves?

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    Medicare Enrollment Deadline Approaching | 7 comments (7 topical)
    Re: Medicare Enrollment Deadline Approaching (none / 0) (#1)
    by ding7777 on Mon May 08, 2006 at 06:38:49 PM EST
    I kept my Mother enrolled with her existing private insurer because: 1. The only way to keep the non-presciption coverage (doctors, therapy, glasses, etc) was to enroll in their Prescription coverage. I didn't want the hassle of finding a new insurer for presciption coverage and a new insurer for non-presciption coverage 2. Supposedly, her insurer will provide coverage even if she hits the "donut hole" -- so why are they sending prescprition expense statements against the "donut hole" target??? 3. Her premium increase was one dollar ($1.00) per quarter, so although she may not benefit greatly from the drug subsidy, she really isn't losing anything compared to prior years 4. No matter which way Congress tweaks Plan D, it will be easier to opt out of the private insurer than trying to opt back in.

    Re: Medicare Enrollment Deadline Approaching (none / 0) (#2)
    by aw on Mon May 08, 2006 at 07:44:34 PM EST
    Mom and I decided to wait. Her prescriptions cost way less than the premiums for now. One thing that bothered me was that the govt insists on knowing about every asset an applicant has. Why? She doesn't have enough income to pay taxes, but she has some modest assets that she draws on to pay her property taxes and emergency home maintenance.

    Re: Medicare Enrollment Deadline Approaching (none / 0) (#3)
    by Che's Lounge on Mon May 08, 2006 at 07:59:53 PM EST
    My stepdad was in a union for 40 years. Need I say more? WTF ever happened to supplemental coverage. Is it too much rocket science to design a system of secondary coverage between the gov and the privates/managed care? Between the incompetent thieves in the government and the smart ones in the insurance industry, we don't have a chance. Jesus Marimba if people can't stomach national health care they must love getting their pockets picked.

    Re: Medicare Enrollment Deadline Approaching (none / 0) (#4)
    by jimakaPPJ on Tue May 09, 2006 at 07:07:05 AM EST
    aw writes:
    One thing that bothered me was that the govt insists on knowing about every asset an applicant has. Why?
    I am a seasoned citizen, and I have Medicare, and I elected the Rx insurance and no one asked me anything about my assets. I would assume that your mother is receiving some type of government assistance. In that case the questions are to determine if she is truly eligible for the assistance. et al - I have never seen so much confusion over something that is not confusing at all. If someone has an existing plan then they should compare that plan with Medicare D and take the best one. I had a plan and it was $130 per month per person, or $260. for my spouse and I. Medicare D worked out to $63. per month for my spouse and $23. per month for me, a net savings of $174. a month. Guess what I did? ;-) There are dozens of insurance companies offering the insurance. Go to the Medicare site and you can get a list. There are numerous options. Basically they break down into three. Option 1 has a $250. deductible, the doughnut hole and stops coverage at about $5K. Option 2 has the deductible, no doughnut hole and caps at about $5K. Option 3 has no deductible, no doughnut hole and no cap. My spouse chose Option 3, I took option 1. Prices vary based on benefits selected. Go the Medicare website and there are some great tools to let you figure it out. Before you start, have a complete list of the drugs being taken and their dosage. Be sure and specify the generic unless your doctor says no. Be sure and use their mail order option for all drugs taken routinely. This is no different than what my private plan did. Using the tools you can figure out what is best. For those who don't have it and don't sign up, they are no different than anyone else not having, say, insurance on a home that is paid for. If it burns, don't complain that you have to replace it out of pocket. ding777 - As noted above, there are numerous plans with no doughnut hole, no cap, no deductible, etc., etc. Che - There are numerous supplemental health care plans out there that will pay the difference between what Medicare pays and what is charged. AARP is one. I.e. Doctor charges $100. Medicare pays 80%, $80 for all you math challenged folks ;-), supplemental pays $20. The trick is to get into a plan at the same time as you go on Medicare. Don't wait until you need it. Now. This is not "Secondary" insurance. Supplemental pays what Medicare does not, or some variation thereof. (Read the benefits of the particular plan.) Secondary pays IF Medicare does not. I.e. Long term nursing home care, long term hospital care, etc. Supplemental is fairly inexpensive, and fairly cost effective. I recommend it for everyone. Secondary is normally expensive, but do the math. Remember that nursing home care coverage stops at 30 days for Medicare. What happens after that varies from state to state, but typically Medicaid can kick in, but that's when homes and other assets must be sold, etc., in most states. Sounds cruel, but if a person has a $500K home, not unusual in many locations, why should the tax payer pay for their nursing care and let the family keep the assets? My solution: National health care paid for by a national sales tax, my best guess, of about 5%. You go to the doctor, the doctor bills the government. Until then, thank George Bush for this plan and curse the Demos who opposed it.

    Re: Medicare Enrollment Deadline Approaching (none / 0) (#5)
    by Che's Lounge on Tue May 09, 2006 at 07:20:40 AM EST
    Jim, The Insurance companies have different plans for your health care dollar. Illegal, but different.

    Re: Medicare Enrollment Deadline Approaching (none / 0) (#6)
    by Talkleft Visitor on Tue May 09, 2006 at 09:14:45 AM EST
    If the retiree doesn't have to pay for the private health care insurance that covers medical and prescription bills, does that weigh further towards keeping the private insurance rather than going with Medicare? Jim, it's not as simple as you make it sound. I did use the prescription drug tables at the medicare site and plugged in her current prescriptions and wasn't able to draw any conclusions. I guess all I am trying to confirm now is that so long as you have "creditable coverage", you can opt in later at no penalty of higher premiums. It sure was easier when there was a flat fee of $7 or $9 per prescription, whatever it was.

    Re: Medicare Enrollment Deadline Approaching (none / 0) (#7)
    by jimakaPPJ on Tue May 09, 2006 at 05:08:57 PM EST
    TL - Then take the top three based on your calculations, call them up and they'll give you the estimated dollars. I did this to confirm my study and received great support. I'm not sure about the opt in later question. Re the $7 or $9 - Only if you had it. My mom had zip and this is a God send for her. She is saving some $400 a month. I still think it funny that a Repub managed this. I guess Nixon to China and all that. Che - I'm no insurance company fan. They will be/are the greatest foe of National Health Care unless we can figure a way to include them in, at a reasonable cost. I tell everyone who complains about how screwed up England is, Canada is, etc., the same thing. We also are screwed up, you just haven't experienced it yet.

    Medicare Enrollment Deadline Approaching | 7 comments (7 topical)