The Part D Medicare Prescription Drug Plan is even more complicated this coming year. If you have a Part D plan now, failure to review upcoming changes for your current plan could cost you hundreds of dollars in 2007. For people who have neither a Part D plan nor other creditable drug coverage (other drug coverage at least as good as Part D), you may want to look into Part D now. The Part D annual enrollment period runs Nov. 15-Dec. 31, and allows everyone with Part D to change to a different plan, and eligible people without Part D to enroll in a plan for the first time.

One of our members reviewed the notice of change she received from her plan and found that her current brand-name drug that costs her a $34 co-pay per month will be classified as a "specialty drug" by her plan in 2007. She'll have to pay 25 percent of the full price in 2007, which amounts to $375 out of her pocket every month for this drug. Armed with this knowledge, she called the Health Plan Information Center to get help to find a Part D drug plan to switch to that will better meet her needs in 2007.

Most people don't have to re-enroll in their current Part D plan every year; with a few exceptions, if you do nothing you'll stay in the same Part D drug plan. But, don't count on your plan staying the same. Many plans are making significant changes. During October, everyone who has Part D received an "Annual Notice of Change" letter along with a new 2007 Formulary (list of covered drugs and their limitations), and a 2007 Summary of Benefits. If you don't have one, call your plan and ask for copy. It will tell you how much your monthly premium is going up or down in 2007, deductible and co-pay changes, "tier" structure changes (the categories of drugs for co-pay determination), and what to do if certain circumstances apply to you. 

Read the letter and then look up your drugs in the 2007 Formulary book so you can compare to how they are handled in 2006.

• Even though there are on average more drugs covered on the formularies (lists of covered drugs) in 2007 than in 2006, there are now many more drugs with limitations such as step therapy, prior authorization or quantity limits, even on drugs you are already taking.

Drug limitations

• Step therapy means you have to try different, less expensive drugs before the plan will cover the drug even if your plan has been covering your drug without step therapy in 2006.
• Prior authorization means that your drug won't be covered unless your doctor writes in to say why similar drugs on the formulary won't work for you.
• If you request an exception because of new limitations, start the process in December. Call your plan or the Senior Federation to get an Exceptions Request form.
• If you are on a drug that you're taking as a result of getting an Exception Request approved in 2006, your letter from the plan will tell you if your plan is ending its exception coverage of your drug at the end of 2006. If it is, you'll have to get another exception request approved for the drug for 2007.

Co-pay changes

• If you pay co-pay dollar amounts instead of percentages, how many categories ("tiers") of co-pays are there? Some plans had two tiers in 2006: one for generics with a low co-pay amount, and a second tier for all brand-name drugs for a higher co-pay amount.

Doughnut hole considerations

Everyone who has Medicare Part D needs to reconsider their coverage for the doughnut hole.  Anyone whose drug prices add up to over $200 per month will hit the doughnut hole in 2007 (the combination of your monthly payments plus your plan's monthly payments for your drugs).  Many people didn't reach the doughnut hole in 2006 because they didn't have Part D for the full 12 months. Others were surprised they reached it because they were under the common misunderstanding that only their own deductible and co-pay amounts accrued toward reaching the doughnut hole, when the reality is that all of the drug plan's payment also accrued toward reaching the doughnut hole.

Unfortunately, the choices for doughnut hole coverage in 2007 are very limited.  While 14 plans cover generic drugs during the doughnut hole, only 3 plans provide much-needed brand-name drug coverage in the doughnut hole.  Two of the three that provide brand-name drug coverage are only available if you join that company's corresponding health plan.  If you will need doughnut hole coverage in 2007, the Senior Federation's Health Plan Information Center or the Senior Linkage Line can help (phone numbers at the end of this article). Anyone who receives Extra Help paying for Part D does not have a doughnut hole.

Penalty surprises

How about those of you who don't have a Medicare Part D plan? If you have other drug coverage that is "creditable," you are probably better off keeping it and you can enroll later without a penalty (within guidelines). Creditable drug coverage includes VA coverage, Tricare for Life, Federal Employee Health coverage and most coverage through an employer or retiree plan. Be sure to get and keep a letter from your drug coverage administrator certifying that it's creditable.

If you don't have any drug coverage, or the drug coverage you have is not creditable, consider enrolling in Part D now while the enrollment penalty is still low. If you didn't enroll last spring when you were eligible, but you enroll now, your the late enrollment premium penalty will always be 7 percent (1 percent per month of not having coverage). For 2007, the monthly dollar amount of your premium penalty would be $1.91 per month (7 percent of $27.35). After Dec. 31, 2006, you won't be able to enroll again until Nov. 15, 2007. Keep in mind that you may need an expensive medication in the future. 

For help choosing a new plan or help with an existing Part D plan, consult the 2007 Health Care Choices. One-on-one telephone assistance can be received by calling the Senior Federation's Health Plan Information Center, 10 a.m. to noon and 1-3 p.m., Monday through Friday at 651/783-5045 (toll-free 866/783-5045). Or call the Senior Linkage Line at 800/333-2433. Face-to-face assistance is available by appointment at the Senior Federation office, 9:30 a.m.-3:30  p.m. Wednesdays through the end of December, and 10 a.m.-2 p.m. on Saturday, Dec. 30. The Medicare Part D prescription drug plan enrollment period ends on Dec. 31, 2007, and you can't enroll or change plans again (with some exceptions) until Nov. 15, 2008.