Health Care Reform:

Part D Open Enrollment: 12 Questions

What about the 'doughnut hole' coverage gap? Has it changed?

Yes, it has. For most plans, Medicare stops paying when your out-of-pocket costs reach $2,510, not including monthly premiums. It doesn't kick in again until you've spent $4,050. Now that people know their plan can drop out, they have to be aware of enhanced plans that charge higher premiums in exchange for more coverage in the doughnut hole.

Aren't there plans that cover drugs in the doughnut hole?

Yes, but Florida is the only state where some plans offer full coverage for all brand name drugs in the doughnut hole. In other states, there is coverage, but it may be only for generic drugs or a limited list of brand-name drugs. So before you buy an enhanced plan, be sure it covers all the drugs you take before you pay a higher premium.

What about coverage restrictions for some drugs?

There are three main restrictions, and they are very important to understand. They are:

• Prior Authorization, which means your doctor may have to contact the plan and tell them you need a certain drug.
• Step therapy, which means you might have to try other similar covered drugs before you can get the drug your doctor prescribes.
• Quantity limits, which is when a plan covers a drug but only at a certain dose.

A study out recently from Georgetown University concludes that more drugs have these restrictions than had them last year.

What if I make my choice on a plan, then discover I made a mistake? What do I do?

If you decide your current Part D plan works for you and you want to stick with it, do nothing and you will automatically be enrolled in the same plan for 2008. If you've picked a plan and decide to change, the very last plan you enroll in is the one that sticks. But I caution people not to wait until the very end of December to do that because your final plan choice may not be reflected right away, and that can be inconvenient when you go to the drugstore. Your best bet is to pick your plan by the second week in December.

And can I change my mind as many times as I need to?

After Jan. 1, everyone is locked into their plan, with a few exceptions. People who get low-income subsidies called extra help can change once per month. People who have a Medicare HMO or Medicare PPO private health plan also have the right to change once from Jan. 1 to March 31. Many of those plans include drug coverage, so if you change that health plan you can change your drug coverage, too.