SHINE On:

Act Now While Window Is Open To Adjust Insurance Coverage

By Sheila Curtis

Attention Medicare Beneficiaries!

It's that time of year to evaluate your medical and prescription coverage. Are you happy with the plan you have? Is it adequate coverage?

November 15-December 31 is the annual open enrollment period during which one can enroll, disenroll, or switch to another Medicare Advantage Plan (HMOs, PPOs). It is also the annual election period to enroll, disenroll or switch to another Medicare Prescription Drug Plan (Part D). If your plan does not cover all your medications, you're not satisfied with the plan you have, or if you just want to find a plan that will cost less, now is the time to make a change.

The Medicare website, www.medicare.gov, has a drug plan finder that will show you which plans cover your medications, the cost of monthly premiums and the cost for each of your medications. In 2007, the basic Part D plan works like this:

• When the total cost of your medications (what you have paid plus what the plan has paid toward your medications) reaches $2,400 you are in the gap (donut hole).
• In the gap, you pay 100 percent of the cost of your medications until you have spent $3,850 out-of-pocket (any money you paid for the deductible, copays and the full cost in the gap).
• Once you have spent $3,850 the plan will pay 95 percent of the cost of your medications for the rest of the calendar year.

If you have very expensive medications you may want to look for a plan that covers through the gap. You have until November 15th to join Prescription Advantage, the state's drug program. This program acts as a supplement to your Medicare Part D plan or other credible drug coverage you may have. Prescription Advantage may assist you with:

• the Part D plan's premium
• the deductible
• capping your copays
• coverage in the gap (donut hole)
• lowering your out-of-pocket costs

The assistance you receive depends on your gross income (not assets) and there is no monthly premium for Prescription Advantage. So don't delay! I urge everyone to at least inquire about this program by calling Prescription Advantage at 1-800-243-4636.

If you would like more information on your options, or need help in choosing a Medicare Part D Prescription Drug Plan, please call the regional SHINE office at 1-800-334-9999 or call your local senior center to meet with a SHINE counselor.

(Ms. Curtis is regional director for SHINE, a state agency Serving the Health Information Needs of Elders.)