In 2008 there is little change in the benefits gap that goes hand in hand with Medicare’s prescription drug program. In addition, open enrollment periods may also bring unscrupulous agents to your door.

Medicare’s Part D prescription drug program, which began in 2006, continues to create problems for seniors left paying for prescriptions that fall in the benefits gap known as the “doughnut hole.” In 2008, the gap will begin when a patient’s total drug costs have reached $2,510, including the portion paid by Medicare and the patient’s own out-of-pocket deductibles and co-payments. From there, the next $3,216 of pharmacy bills are out-of-pocket until the bills total $5,726. Only then does the Medicare coverage resume.

In order to get benefits under Part D, Medicare beneficiaries must enroll in one of the plans offered by private insurance companies that contract with the federal agency. These plans’ options include managed care such as HMOs, PPOs, and Private Fee for Service plans. The National Senior Citizens Law Center (NSCLC) reports that of the 44 million Medicare beneficiaries, 23.9 million are enrolled in a Part D plan.

So while people are struggling through the doughnut hole, they still have to keep paying their monthly premiums — typically $30 or more — even as they pay in full for prescriptions.

According to the New York Times, the poorest patients can receive federal assistance with premiums, deductibles, and co-pays under the Medicare program. But those who don’t qualify for this help, and cannot get any other help, “sometimes simply stop taking their medications once they reach the doughnut hole or rack up big credit card debt to pay for them,” the paper reports.

Some of the options seniors have are switching to generic drugs — though not all drugs have generic equivalents — or switching to a different type of drug that might be cheaper. Some clinics will supply patients with free samples from brand-name drug companies.

Although the open enrollment period for these plans has passed, seniors may have been shocked to discover that their premiums for 2008 went up. According to the NSCLC, the least-expensive plan’s premium was going up by 167 percent in New York, 96 percent in California, 90 percent in Florida, and 44 percent in Pennsylvania. Considering that plans often handle prescription drug requests and payments differently, changing to a new plan can be a difficult process for seniors.

In addition, during open enrollment, seniors may find themselves the target of high-pressure sales tactics, according to Mary Jo Hudson, director of the Ohio Department of Insurance.

“Medicare Advantage Open Enrollment allows people on Medicare to make a single plan election into or out of a Medicare Advantage Plan,” says Hudson on the department’s Web site, www.ohioinsurance.gov. “Beneficiaries should carefully evaluate their plan options, not be pressured into making a quick decision, and be on the lookout for misleading sales pitches and promises that seem too good to be true.”

You don’t need to use an agent to obtain coverage. When you decide to think about switching plans again, protect yourself by doing the following:

• Don’t provide any personal information to anyone unless you are certain you will make a purchase. Even then, don’t sign any paperwork without a family member or trusted adviser to confirm that the product meets your needs.
• Be wary of agents who sell Medicare products door-to-door and agents who claim to work for Medicare. Medicare representatives do not enroll beneficiaries by making house calls.
• Contact your healthcare provider to verify that they are a participating Medicare provider or accept the plan you are considering.
• Contact your state’s insurance department or your State Health Insurance Assistance Program to learn more about what plans your state might offer to help fill the Medicare gap.