Tuesday, December 05, 2006


The next couple of weeks will be slamma-jamma on the phone lines where I work, as we are getting into the heart of the open enrollment period for the Medicare Part D prescription drug programmes. While the enrollment period lasts until December 31, Medicare is urging people to make a decision and get enrolled by this coming Friday, December 8. Why?

All applications must be approved by the Centers for Medicare and Medicaid Services, the federal agency which oversees the entire programme. Because of the simple volume of applicaitons they will have to deal with, it can take between two and three weeks for an application to be processed and approved, after which CMS informs the provider, who in turn notifies the applicant by letter that they have been approved. Those who wait until later in December to make up their minds may not have their benefits in place until possibly mid-January, which means they will have to pay out of pocket for their medications until their application has been processed and approved. The benefits will be made retroactive to January 1, but that may not help some poor folks. Making a decision early --- this week --- on who you want to provide your prescription drug benefits could mean the difference of being ready come January 1 or paying out of pocket for awhile.

Another important point: READ THE FORMULARY! The formulary is the list of drugs that a provider will offer as part of their plan. Just because a doctor prescribes a certain medication doesn't mean that 1) it will be covered, or 2) it will be covered at the dosage you may currently take. Oxycontin seems to be the pain drug of choice right now, and the plan that I represent does not include Oxycontin or Oxycodone on it's formulary. The formulary alternative that is being required that members try for a period of 60 days is Morphine Sulfate Solution (MSSR) before Oxycontin/Oxycodone will be considered.

Also, DON'T RELY ON FRIENDS, NEIGHBOURS, OR MEDICARE for your information. Every Part D provider offers packets of information regarding their plans, and it's important that you get the provider's information to get a complete look at how their plans work, what mundane requirements you may have to meet, co-payment and premimum information. Read the information carefully, sitting down if needed with a friend/neighbour/relative to review it to insure a full understanding of the plan. And don't be afraid to call and ask questions if needed.

And one problem that we've come across quite a bit is...family members attempting to enroll mom/dad/grandparents when they don't have the legal right to do so. To do that you MUST have a POWER OF ATTORNEY DOCUMENT FOR HEALTHCARE ISSUES, and you cannot enroll them online or via phone; you must fill out the paper enrollment application and include a copy of the POWER OF ATTORNEY document with the application. To do otherwise is considered forgery.

Just a few basic things to help if you're helping a friend or relative. I'll probably have more here later.


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