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Sorting Out Medicare Drug optionsMedicare Prescription Plan Prep

Posted on: Thursday, 25 August 2005, 21:00 CDT

If you or someone you love is on Medicare, disabled or over age 65, it's time to mark your calendar, start a file and sharpen your pencil.

Signing up for Medicare's 2006 prescription drug coverage stands to be a little like filing your income taxes:

It will involve documents, deadlines and multiple options.

Do it right and you could end up saving a bundle, but you could face penalties if you act too late.

Everyone's situation will be different. And millions will be trying to sort it out -- and storming help lines -- at once.

Those are among the reasons Health and Human Services Secretary Mike Leavitt planned to visit Omaha, Lincoln and Des Moines today as part of a national tour to help people prepare.

"We're trying to say: 'This is coming, and you have to think about this,'" Leavitt said by phone during a stop in Louisiana earlier this week. "It's not only seniors we're trying to reach, but also the children and nieces and nephews and friends they will ask for help."

The new coverage, called Part D and established by the Medicare Modernization Act of 2003, is perhaps the biggest change in the program's 40-year history.

It will affect the 40 million Americans who now receive Medicare, including more than 257,000 in Nebraska and 482,000 in Iowa. It's intended to provide them with less costly access to prescription drugs.

Starting in January, Part D will replace the Medicare drug discount card, begun this year as temporary help. It also will replace Medicaid prescription coverage for people on both Medicare and Medicaid.

Much like private insurance, the new Medicare drug benefit will cover generic and name-brand prescription drugs in exchange for co- payments, deductibles and monthly premiums from those enrolled.

All Americans on Medicare (federally supported health insurance for people 65 and older, younger but disabled, and those of any age with end-stage kidney disease) can enroll for drug coverage between Nov. 15 and May 15.

Medicare recipients who wait to enroll in Part D after May 15 will face higher premiums for life if they don't already have comparable or better drug coverage from another source, such as a union or former employer.

Private Medicare-approved companies in each state will administer the coverage, and senior citizens and others on Medicare will have several plans to choose from by mid-October.

Though not all plans will cover all drugs, they must cover generic and brand name drugs, at least two drugs in every drug class and "substantially all" drugs for conditions such as cancer, HIV and AIDS.

Still, a husband and wife might end up with different plans based on what drugs they take, said Robin Szwanek, associate state director for community outreach at AARP Nebraska.

They also might have to switch to different brands of drugs or appeal to have their brands included if no plan covers all their particular drugs.

Szwanek cautioned that so-called "dual eligibles" (the 38,000 Nebraskans and 69,000 Iowans who are on both Medicare and Medicaid) must select a plan or risk being automatically enrolled in one that doesn't cover their particular medications.

Under the basic benefit, most who enroll will pay about $32 a month for drug coverage, plus a $250 deductible and a co-payment for each prescription. The plan will cover 75 percent of a person's annual drug costs between $250 and $2,250, nothing between $2,250 and $5,100, and about 95 percent after the person has spent $3,600 out-of-pocket.

Those with low incomes may qualify for extra help with out-of- pocket costs. The poorest will pay no premiums or deductibles and $5 or less for each prescription.

Medicare officials estimate that those who lack drug coverage now can expect to save about 50 percent on total drug spending, or about $1,100 per person per year on average, if they enroll in the basic plan and don't qualify for extra help.

A new report by Medicare Today put the savings even higher. It estimated the 11.8 million senior citizens who now lack prescription drug coverage will see their out-of-pocket costs fall by two-thirds -- from $1,905 to $626 a year.

Medicare beneficiaries with drug coverage through another source -- such as a Medigap, union or employer policy -- may see savings, too, but they'll have to compare plans to find out.

Details of the plans offered in each state are expected in October.

In Nebraska, a statewide coalition has trained hundreds of volunteers and professionals who will answer phones, provide counseling, and organize local sign-up workshops come November.

Until then, they are working to get the word out to senior citizens and others that crunch time -- like tax time -- is coming.

Medicare prescription plan prep

Already confused about the Medicare Rx drug plan? Here's what you can do:

NOW

Gather basic details about your current drug coverage and spending, income and assets, what prescription drugs you take, and any mail related to the Medicare prescription drug benefit. Check to see whether you qualify for extra help (a cheaper plan) and apply for it at www.medicare.gov, www.socialsecurity.gov or by calling your local Social Security office.

OCTOBER

Get details about plans offered in your state at your SHIIP office (call (800) 234-7119 in Nebraska or (800) 351-4664 in Iowa), at www.medicare.gov, or in the "Medicare & You 2006" handbook mailed to beneficiaries in October. Watch the mail for information from the current provider of your prescription drug coverage (if you have it) about whether that coverage is "creditable" (comparable or better than Medicare's new coverage). If it is, there's no hurry to enroll. If it isn't, you'll pay higher premiums if you enroll after May 15. Stay tuned for news about local resources and sign-up workshops.

NOV. 15 - MAY 15

Enroll in the new drug coverage if it's right for you.

JAN. 1:

Begin receiving prescription drug coverage if you've enrolled. Stop using Medicare drug discount card.

Source: Omaha World - Herald

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