Anyone who is already on Medicare and wants to join or change a Medicare Advantage plan, or a Part D plan, must do so by this Friday, December 7th.

If you are happy with your current Medicare coverage, you don’t have to do anything. Your Medicare Advantage plan, or your Part D plan will roll over for 2013.

If you have some issues with your Medicare Advantage plan or Part D plan, you need to act quickly because the deadline for for most people to make a change is this Friday, December 7th.

Who is not affected by the Open Enrollment deadline?

If you have a Medicare supplement and the premium has gone up more than 20%, you might consider changing to another company – and the December 7th deadline does not apply to you. You can change your Medicare supplement at any time during the year (if you are healthy or in a guaranteed issue period).

If you are turning 65 in December or January (or later) the December 7th deadline does not apply to you.

If you have employer retiree coverage you are thinking about dropping (if you can), the December 7th deadline does not apply to you.

If you have recently moved to Arizona, or a new state, the deadline does not apply to you.

If you get help with your Part B premium or your drug costs, you can change your Medicare Advantage plan or your Part D plan any time during the year.

If you have Medicare AND Medicaid (AHCCCS in Arizona), you can change your Medicare Advantage plan any time during the year.

Making changes? Doctors and Drugs need to be checked.

Don’t wait until the last day of Open Enrollment (Friday, December 7th) to make a change. You can’t just pick another Advantage plan or Part D plan. You must be sure your doctors are in-network if you are considering a Medicare Advantage plan. And you must make sure your drugs are covered and what your cost will be.

If you make the wrong choice because you did not do your research (or have an insurance agent do this for you), you will be stuck in that plan for all of 2013.

I got a call from a woman who is turning 65 in March. She said her friend told her she has to sign up for Medicare Part D or a Medicare Advantage plan before December 7th. That is the end of the Medicare Open Enrollment Period. Her friend is wrong.

A person turning 65 has an initial enrollment period (IEP) that begins three months before she turns 65 and ends three months after the month in which she turns 65. So this  woman’s IEP runs from December through June.  Most people will enroll in Part D or a Medicare Advantage plan before their Medicare begins, so it is set up and ready to go on the first day of the month in which they turn 65.

The Medicare Open Enrollment Period (October 15 – December 7) is for people who already have Medicare Advantage, or Part D, or just Medicare.

**If a person has Medicare now, but never signed up for Part D, or a Medicare Advantage plan, this is the time of year when they can enroll in this type of coverage.  However, that person will have a penalty for not enrolling in Part D when they first turned 65, and that will increase their Part D cost.

**If a person has Medicare plus a supplement (medigap) plus Part D, they can opt to drop their supplement and enroll in Medicare Advantage plan with Part D (MAPD).

**If a person wants to change from his Medicare Advantage plan to another Medicare Advantage plan, now is the time to do that. The new plan would take effect on January 1st.

I have also worked with many people who continued working after they turned 65, and those people do not have to worry about the Open Enrollment Period. They get a “Special Enrollment Period” when they start their Part B of Medicare – but they don’t get as much time to sign up for Medicare Advantage or Part D.  They need to plan ahead so their Advantage plan or Part D will begin right when their Medicare Part B starts.

So many rules…. so many choices….. so confusing!  This is why people need to work with a knowledgeable insurance broker.

Here is a short Introduction to Your Medicare Choices.

There are 1,736 Part D prescription-drug plans available to people on Medicare. In Arizona, seniors have 26 plans to consider.  According to a recent study by Health Affairs, seniors on on average overspend by $368 more per year on their Medicare prescription drug plans because they tend to pay for more than they need.  The study concluded that only 5.2% of seniors chose the most economical Part D plan available to them.

I’m sure the folks who studied Medicare Part D are very smart people – but it doesn’t take a PhD to figure out what’s wrong with the program. There are too many plans!

There are too many plans, and each plan is a bit different from the others: Some drugs aren’t covered on some plans.  On one Part D plan a brand drug co-pay might be $45, while that same drug will cost $95 on another plan.

Another problem I see with Part D is that the plans change every year. Some plans change a lot while others change just a little.

Last year, one Part D plan raised its premium from $32 in 2011 to $72 for 2012. I wrote about that last year around this time. In January, a woman read my blog and emailed me to say she had just realized she was in that plan and had not read her Annual Notice of Change (ANOC).  At that point it was January, and she was stuck in that $72 per month plan for the rest of 2012. I told her to call Medicare and ask for an exception – but I told her they’d probably say, “Tough luck! You should have read the materials your Part D plan sent you in September!”

Part D plans come as “stand-alone” when a person is on “Original Medicare”. These folks use their Medicare card when they go to the doctor.  But Part D also comes as part of most Medicare Advantage plans.  The Part D in a Medicare Advantage plan works the same as the stand-alone plan. They all have co-pays and they all have the donut hole.

Some Advantage plans offer some very good benefits in their Part D. One company covers the full cost of insulin for people enrolled in their Diabetes plan.  Another Advantage plan has a $10 co-pay for insulin, and this plan even covers insulin pens for a $10 co-pay.  Sorry, I can’t name names, or I’d be seen as promoting these plans.

Another Advantage plan has always had a really good deal for their enrollees who use their mail order.  Brand drugs could be ordered by mail and a person would get three months for the price of two. So instead of paying $135 for a 90-day supply, people would pay just $90. But in 2013, people in this Medicare Advantage plan are going to be surprised (maybe shocked) to learn they no longer get this big price break.

I wonder how many people have found this bit of information in their annual notice of change. Advantage plans and stand-alone Part D plans are required to inform people of changes to their plans for the next year – but very few people read the details of the ANOC.  In January or February, when they get the bigger bill for their meds, it will be too late to change their Advantage plan.

I really get peeved by Part D because of the things I’ve written about here. It just seems so wasteful that 1,700+ plans are spending money on marketing and materials, and figuring out how to make a profit.  Sure, seniors have lots of plans to choose from.  But do they really want so many choices? And can they deal with the changes that happen every year? And are they saving money because of all the choices?

The Health Affairs study says the answer to my last question is “no”. Seniors are not benefiting from having so many choices. And I’m pretty sure Medicare is not saving money. It really seems like a dumb way to offer prescription coverage to people on Medicare. Of course, the insurance companies (and Paul Ryan) think it is a brilliant way to run a very expensive Medicare program that is vital to so many seniors and people with disabilities.