Open Season, Times Two.

In past years, my October article has always been about the Medicare open season or more correctly titled, “Annual Election Period.”   This year’s October article will also follow that same path, and years 2011, 2012 and probably 2013, will also 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.  The State of Washington instituted a semi-annual open enrollment period for persons under the age of 19 to purchase health insurance.  This period will run from September 15th through October 31st, 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 parents 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 October 15th to December 7th.  Yes folks, the same December 7th 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 their Medicare coverage for either a Medicare Advantage Plan, or a stand alone Part D prescription drug plan, they will have their new ID cards in hand prior to the January 1st effective date, and have a smooth transition from one plan to the other.

From my initial review of plan details which were released on October 1st,

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. This is where I try not to bore too many people as I do go into some details and numbers. So here goes.

In 2012 Washington State 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 programs existence.

Of those 30 plans, 27 are continuing plans with 5 plans having chosen to leave the marketplace and 3 new plans entering.

Four of the five sponsors will have other plans available in the state and will just move clients to another of their options.  The only plan that is leaving without a replacement is a plan offered by Rx America and was co-branded with CVS (a large national drug store chain with no Washington State 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, 9 have actually 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 actually purchased the Community Care CCRx  product line from Universal American.  For 2012 Silverscript will be offering both product lines, but as of this date have not appointed any agents to represent the Community CCRx plans. Silverscript have further expanded their branding efforts with the CVS drug stores.  Envision Rx is now co-branding with Rite-aid. We are even 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 Wal-Mart, 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 Wal-Mart plan $15.10 because it has a $0 deductible whereas the Humana plan has a $320 deductible, I would strongly recommend that you, and 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 me 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 their Annual Notice Of Change (ANOC) 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 web-site 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 7 days a week from calling those same folks at Medicare at 1-800-633-4227.  Local help is also available in person from visiting the local Statewide Health Insurance Benefit Advisor’s (SHIBA) located at 411 W. Washington St or your local insurance agent.

Posted on: October 10th, 2011 at 4:56pm by aveadmin12. Filed under: Uncategorized
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