Advice
I wrote the following article for my hometown newspaper. I know the Editor that handles the genre. I sent it to him and asked him for some pointers but not before I actually asked him for permission to impose. He assured me that he would gladly help. I submitted the article and then I paid him a visit to inquire as to the progress. He told me he would definitely get back to me. I never heard from him. Some articles were printed about the same topic, but my article submission was ignored. I was greatly perturbed by the whole incident. I don’t understand what went wrong. So I have decided to post it on my blog to see if anyone can give me some advice. What did I do wrong? Is the article such a complete mess that he was being polite in not responding? The article follows:
Independent, individualists, capitalists, lovers of the free market, these are all terms that can be used to describe most Americans and certainly Generation A, the generation of Americans that came before the Baby Boomers. Generation A thrived on these concepts. Yet, as they are now either retired or retiring, they are daunted by the prospect of choosing insurance coverage offered by the new Medicare benefits packages; Packages that are so varied, with so many different offerings, for the specific purpose of catering to the individual, that they have managed to frighten and confuse those they were created to serve.
These packages have been created with the idea of rugged individualism and offer Generation A a number of options to suit their own lifestyles. These packages are differing plans offered by private insurance companies and tailored to the individual needs of each Medicare client. Various websites offer assistance, such as www.medicare.gov, www.eldercare.gov, www.aarp.org/bulletin/medicarerx/, and finally www.aoa.gov, to contact the Administration on Aging. There are also a number of agencies you may call such as your Area Agency on Aging (the specific office in your area can be located by visiting the eldercare.gov web site), or you may call the Senior Health Insurance Assistance Program in your state, or you may call the Coordinator of Benefits Contractor at 1-800-999-1118. In addition, your doctor’s office or other social service agencies also have experts willing to give advice. But before you contact one of these agencies, read on for steps to make it easier for you to make your decisions.
Understand that time requirements limit the decision making process, as each Medicare recipient must have chosen their plan by May 15, 2006. Many are experiencing problems and feeling frustrated with the new program. The problem seems to lie with the very benefit these plans were designed to offer, individualized options. There are so many different options available that many are confused. Allowing the government to choose your plan, as they will do for some previous Medicaid recipients and those with lower incomes, does not guarantee that it will be the best plan for you. Understand also that agencies listed have been and continue to be inundated by calls. One agency worker, bemoaned his plight and insisted that they would never be able to answer the questions of all those calling for assistance. He blamed it on the government, calling it poorly planned. However, you can help him help you by doing a bit of research and preparation.
While it is confusing because one cannot possibly try to understand or learn all of the ins and outs of each plan, there is hope for the individual. One point to remember is that if you are already covered, your provider must report whether or not your current plan is at least as good as the new Medicare plans offered. They should have already sent you a letter with this information included; if they haven’t contact your benefits administrator before making any changes. Secondly, remember that you are only locked into any plan that you choose from May 15, 2006 until December 31, 2006. You may change or join a new drug plan from November 15 through December 31 each year which is the enrollment period, and the coverage will be in effect as of the following January 1. (As an aside, if the government selects a plan for you and it does not suit your purposes, you may change it at any time.) The trick is to pick a plan and enroll by the May deadline, so that you never have to pay a penalty.
There are three parts of Medicare that may be considered in the decision making process, Medicare Part A, which covers hospital insurance, Medicare Part B, which covers medical insurance, and the Medicare Prescription Drug Plans (PDP) or Medicare Advantage Plans which include prescription drugs (MA-PD), and also include Managed Care Plans (like an HMO), Preferred Provider Organization Plans (PPO), Private Fee-for-Service Plans (PFFS), and Special Needs Plans, all of which are collectively called Medicare Part D plans. Be careful when deciding because by choosing some of the above plans, you change not only your drug plan but also your hospital and medical insurance.
Some people had Medigap coverage that also covered prescription drugs. You are no longer able to buy a Medigap policy that covers prescription drugs. Medigap policies will still be available but without prescription drug coverage. Medigap plans A-J, which have higher coinsurance and deductibles, and Medigap plans K and L, which limit costs for doctor’s services and hospital care, are some of the options available; they are for those that have the Original Medicare Plan.
If you have a plan that is at least as good as the Medicare plans available, then you may remain in your plan; if that plan changes or you lose it for some reason, you can always then join one of the Medicare plans without worrying about paying penalties. If your plan changes or you find that you need a Medicare Prescription Plan at a later date, you have 63 days to sign up.
The problem with the new Medicare Prescription Drug coverage plans is that many will be required to pay at least $5100 yearly out of pocket costs; however, you can lower that amount if you are careful of the plan you choose.
The first steps to choosing the best plan follows: Each individual should make a list of their prescription and their probable medical needs and then call one of the agencies listed above or visit the websites listed. There you can find the plans available in your area. Next, contact the plan providers and using your specific list of prescriptions and medical needs shop for the best services for the lowest prices! There is a Medicare Prescription Drug Plan Finder tool on the internet at www.medicare.gov. You will need to have your Medicare number and the effective dates of either Medicare Part A or B, also some of your specific personal information, including prescription names, dosages, and your current costs. Refer to the questions below to determine the best plan for you.
If you choose to call specific companies offering the Medicare Prescription Drug Plan, then make sure they are displaying the official Medicare Seal in their advertisements. Some of the questions you will need to get answers for are listed below: First, ask if there is a list of prescription medicines the plan will cover and remember to get it in writing. Have them send it to you before you choose or find out if you can access it through the internet. Secondly, ask about prices. What is the monthly premium? What is the co-insurance? What are the co-payments, and deductibles? Do you have to pay a co-pay when filling a prescription? Is there a process to have a prescription approved? How long does the process take? Also, is there an appeal process and how long does it take? How are the prescriptions filled? Are you required to use specific pharmacies? Are you able or required to use mail order services? Armed with the answers to these questions each individual should be able to find the best plan for them. Again remember to get everything in writing. Also, remember that they cannot ask for payment up front. They must mail you a bill. If you decide to choose a Medicare Advantage Plan, a Managed Care Plan, a Preferred Provider Organization Plan, a Private Fee-for-Service Plans, or a Special Needs Plan then you must ask questions specific to your medical needs in terms of medical insurance and hospital insurance.
Lastly, if there are things you are unsure of then do some research. A list of CMS publications by name and number, that can be accessed at the Medicare website follows: 02110 Choosing A Medigap Policy: A Guide to Health Insurance for People With Medicare; 02179 Medicare and Other Health Benefits: Your Guide to Who Pays First; 10116 Your Medicare Benefits; 10134 Does Your Doctor or Supplier Accept “Assignments.”; 11036 Enrolling in Medicare; 11163 Things to Think About When You Compare Plans; 11109 Your Guide to Medicare Prescription Drug Coverage; 10050 Medicare and You 2006; 10112 Your Medicare Rights and Protections; 02219 Choosing a Medicare Health Plan; 11135 Quick Facts about Medicare’s New Coverage for Prescription Drugs for people with a Medicare Health Plan with prescription drug coverage; 11061 The Facts About Medicare Advantage; 11103 Introducing Medicare’s New Coverage for Prescription Drugs; 11065 The Facts About Medicare Drug Plans; 11146 What Medicare Prescription Drug Coverage Means to You. All of these publications can be downloaded for free at www.medicare.gov. Some are available in large print. You may also call to request these publications at 1-800-633-4224.
I am urging all you rugged individuals to take the bull by the horns and conquer this latest challenge. Surely, our retirees, who helped defined the term, rugged individualist, will not retreat into the stance of a victim. This task is not too daunting for you, surely! You are the trail blazers. Soon the Boomers will enter this new phase in their lives; and as they are a much larger group, they will be in need of a system that has had all the kinks worked out if it. Once again, you, Generation A, are the trailblazers!
Independent, individualists, capitalists, lovers of the free market, these are all terms that can be used to describe most Americans and certainly Generation A, the generation of Americans that came before the Baby Boomers. Generation A thrived on these concepts. Yet, as they are now either retired or retiring, they are daunted by the prospect of choosing insurance coverage offered by the new Medicare benefits packages; Packages that are so varied, with so many different offerings, for the specific purpose of catering to the individual, that they have managed to frighten and confuse those they were created to serve.
These packages have been created with the idea of rugged individualism and offer Generation A a number of options to suit their own lifestyles. These packages are differing plans offered by private insurance companies and tailored to the individual needs of each Medicare client. Various websites offer assistance, such as www.medicare.gov, www.eldercare.gov, www.aarp.org/bulletin/medicarerx/, and finally www.aoa.gov, to contact the Administration on Aging. There are also a number of agencies you may call such as your Area Agency on Aging (the specific office in your area can be located by visiting the eldercare.gov web site), or you may call the Senior Health Insurance Assistance Program in your state, or you may call the Coordinator of Benefits Contractor at 1-800-999-1118. In addition, your doctor’s office or other social service agencies also have experts willing to give advice. But before you contact one of these agencies, read on for steps to make it easier for you to make your decisions.
Understand that time requirements limit the decision making process, as each Medicare recipient must have chosen their plan by May 15, 2006. Many are experiencing problems and feeling frustrated with the new program. The problem seems to lie with the very benefit these plans were designed to offer, individualized options. There are so many different options available that many are confused. Allowing the government to choose your plan, as they will do for some previous Medicaid recipients and those with lower incomes, does not guarantee that it will be the best plan for you. Understand also that agencies listed have been and continue to be inundated by calls. One agency worker, bemoaned his plight and insisted that they would never be able to answer the questions of all those calling for assistance. He blamed it on the government, calling it poorly planned. However, you can help him help you by doing a bit of research and preparation.
While it is confusing because one cannot possibly try to understand or learn all of the ins and outs of each plan, there is hope for the individual. One point to remember is that if you are already covered, your provider must report whether or not your current plan is at least as good as the new Medicare plans offered. They should have already sent you a letter with this information included; if they haven’t contact your benefits administrator before making any changes. Secondly, remember that you are only locked into any plan that you choose from May 15, 2006 until December 31, 2006. You may change or join a new drug plan from November 15 through December 31 each year which is the enrollment period, and the coverage will be in effect as of the following January 1. (As an aside, if the government selects a plan for you and it does not suit your purposes, you may change it at any time.) The trick is to pick a plan and enroll by the May deadline, so that you never have to pay a penalty.
There are three parts of Medicare that may be considered in the decision making process, Medicare Part A, which covers hospital insurance, Medicare Part B, which covers medical insurance, and the Medicare Prescription Drug Plans (PDP) or Medicare Advantage Plans which include prescription drugs (MA-PD), and also include Managed Care Plans (like an HMO), Preferred Provider Organization Plans (PPO), Private Fee-for-Service Plans (PFFS), and Special Needs Plans, all of which are collectively called Medicare Part D plans. Be careful when deciding because by choosing some of the above plans, you change not only your drug plan but also your hospital and medical insurance.
Some people had Medigap coverage that also covered prescription drugs. You are no longer able to buy a Medigap policy that covers prescription drugs. Medigap policies will still be available but without prescription drug coverage. Medigap plans A-J, which have higher coinsurance and deductibles, and Medigap plans K and L, which limit costs for doctor’s services and hospital care, are some of the options available; they are for those that have the Original Medicare Plan.
If you have a plan that is at least as good as the Medicare plans available, then you may remain in your plan; if that plan changes or you lose it for some reason, you can always then join one of the Medicare plans without worrying about paying penalties. If your plan changes or you find that you need a Medicare Prescription Plan at a later date, you have 63 days to sign up.
The problem with the new Medicare Prescription Drug coverage plans is that many will be required to pay at least $5100 yearly out of pocket costs; however, you can lower that amount if you are careful of the plan you choose.
The first steps to choosing the best plan follows: Each individual should make a list of their prescription and their probable medical needs and then call one of the agencies listed above or visit the websites listed. There you can find the plans available in your area. Next, contact the plan providers and using your specific list of prescriptions and medical needs shop for the best services for the lowest prices! There is a Medicare Prescription Drug Plan Finder tool on the internet at www.medicare.gov. You will need to have your Medicare number and the effective dates of either Medicare Part A or B, also some of your specific personal information, including prescription names, dosages, and your current costs. Refer to the questions below to determine the best plan for you.
If you choose to call specific companies offering the Medicare Prescription Drug Plan, then make sure they are displaying the official Medicare Seal in their advertisements. Some of the questions you will need to get answers for are listed below: First, ask if there is a list of prescription medicines the plan will cover and remember to get it in writing. Have them send it to you before you choose or find out if you can access it through the internet. Secondly, ask about prices. What is the monthly premium? What is the co-insurance? What are the co-payments, and deductibles? Do you have to pay a co-pay when filling a prescription? Is there a process to have a prescription approved? How long does the process take? Also, is there an appeal process and how long does it take? How are the prescriptions filled? Are you required to use specific pharmacies? Are you able or required to use mail order services? Armed with the answers to these questions each individual should be able to find the best plan for them. Again remember to get everything in writing. Also, remember that they cannot ask for payment up front. They must mail you a bill. If you decide to choose a Medicare Advantage Plan, a Managed Care Plan, a Preferred Provider Organization Plan, a Private Fee-for-Service Plans, or a Special Needs Plan then you must ask questions specific to your medical needs in terms of medical insurance and hospital insurance.
Lastly, if there are things you are unsure of then do some research. A list of CMS publications by name and number, that can be accessed at the Medicare website follows: 02110 Choosing A Medigap Policy: A Guide to Health Insurance for People With Medicare; 02179 Medicare and Other Health Benefits: Your Guide to Who Pays First; 10116 Your Medicare Benefits; 10134 Does Your Doctor or Supplier Accept “Assignments.”; 11036 Enrolling in Medicare; 11163 Things to Think About When You Compare Plans; 11109 Your Guide to Medicare Prescription Drug Coverage; 10050 Medicare and You 2006; 10112 Your Medicare Rights and Protections; 02219 Choosing a Medicare Health Plan; 11135 Quick Facts about Medicare’s New Coverage for Prescription Drugs for people with a Medicare Health Plan with prescription drug coverage; 11061 The Facts About Medicare Advantage; 11103 Introducing Medicare’s New Coverage for Prescription Drugs; 11065 The Facts About Medicare Drug Plans; 11146 What Medicare Prescription Drug Coverage Means to You. All of these publications can be downloaded for free at www.medicare.gov. Some are available in large print. You may also call to request these publications at 1-800-633-4224.
I am urging all you rugged individuals to take the bull by the horns and conquer this latest challenge. Surely, our retirees, who helped defined the term, rugged individualist, will not retreat into the stance of a victim. This task is not too daunting for you, surely! You are the trail blazers. Soon the Boomers will enter this new phase in their lives; and as they are a much larger group, they will be in need of a system that has had all the kinks worked out if it. Once again, you, Generation A, are the trailblazers!
posted by R.A. Holloway | 2:41 PM
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