Encore Management

WHAT YOU NEED TO KNOW

For Whom Did The May 15, 2006 Deadline to Enroll in a Prescription Drug Plan Primarily Apply?

• Seniors who have the following categories of health coverage
• Original Medicare (Medicare A/B) with No Current Drug Coverage
• Original Medicare (Medicare A/B) with a Medicare Supplemental Policy with Drug Coverage since it is more likely to "not be creditable".
• These seniors will need to select a "Stand Alone" Prescription Drug Plan
• People under a Federal or State Financial Assistance Program were already auto-enrolled in a plan prior to May 15th.
• If that randomly assigned plan does not meet their needs, after May 15th they still have at least one additional opportunity to switch to another plan.
• Dual-eligible Medicare and Medicaid (Medi-Cal) beneficiaries can switch plans once a month.

To Select a "Stand Alone" Prescription Drug Plan You MUST Use a Web-Based Tool

• You cannot make an informed decision unless you use a web-based tool.
• This must be repeated for emphasis:

You cannot make an informed decision on a prescription drug plan
unless you use a web-based tool 

• Primary web-based tool is the Drug Plan Finder at www.medicare.gov.
• Goal is to select a plan whose "formulary" covers all of a senior's current drugs.
• Enter medication name, dosage and 30-day supply.
• Plan offerings will be sorted from least to most expensive total estimated annual cost including premiums, deductibles, copays and coinsurance.
• Make sure the plan covers any required pharmacies (particularly applicable for rural seniors or seniors on medications management living in skilled nursing or assisted living.)

Of Special Note

• If in a disease state where drug protocol is reasonably known, contact doctor to get names of drugs that might be prescribed later in the year and should be considered a "current" drug.
• If currently taking no drugs chose the lowest premium plans a safeguard in case drugs are prescribed during the year and to avoid the penalty for late enrollment.

Where to Get Help

• www.medicare.gov
• 1-800-MEDICARE
• Your state's health insurance program
• In California, known as HICAP.  1-800-434-0222
• Best source on free assistance for those on government financial assistance programs.

Enrollment

• Enrollment on the plan provider's web-site is preferable.
• Can also enroll:
• By phone to plan provider
• By phone to 1-800-MEDICARE
• Through www.medicare.gov

What's Next

• Expect to do an annual plan review to determine which plan's formulary covers a senior's then current set of drugs.
• Take list of drugs to next doctor's appointment to discuss potential drug interactions.