Improved Medicare Plans Unveiled
By Morgan Kelly
What it means for you Under the new rules, Medicare plans take effect after a member has spent $250 on drugs in a particular year. From there, the plan pays 75 percent of costs until medicine expenses reach $2,250, after which seniors are on their own until costs reach $5,850. Plans available in West Virginia Standard, stand-alone plan providers: * Aetna Life Insurance Co. * American Progressive Life and Health Insurance Co./Marquette National Life Insurance Co./Pennsylvania Life Insurance Co. * Connecticut General Life Insurance Co. * Coventry Health and Life Insurance Co./First Health Life and Health Insurance Co. * Highmark Senior Resources Inc. * Human Insurance Co. * Medco Containment Life Insurance Co. * Memberhealth Inc. * Pacificare Life and Health Insurance Co. * QCC Ins Co. D/B/A Amerihealth Insurance Co. * RxAmerica LLC * Silverscript insurance Co. * Sterling Life Insurance Co. * Unicare * United American Insurance Co. * United Health Care Insurance Co. * UPMC Health Plan * Wellcare Health Plans Medicare Advantage plans: * Humana Inc. * Coventry * Health Plan of the Upper Ohio Valley * Mountain State Blue Cross Blue Shield Source: Centers for Medicare and Medicaid Services
mkelly@wvgazette.com
With less than two months left until West Virginia’s seniors choose their new Medicare drug plan, federal administrators revealed Friday the companies they can turn to for help.
But few details were given as to what help seniors would get in affording the sizeable financial gaps in each plan’s coverage.
Beginning Nov. 15, beneficiaries in West Virginia will have about 19 standard plans from which to select. The plans begin Jan. 1 and all Medicare recipients qualify for the standard plans.
Four other plans will be available under Medicare Advantage, which offers more benefits and better co-pays, but also has certain eligibility requirements. Advantage-registered seniors can go to a hospital or doctor of their choice for an extra fee.
During a conference call with reporters Friday morning, Dr. Mark McClellan, administrator for the Centers for Medicare and Medicaid Services, said competition among plan providers had resulted in lower prices and better benefits than originally thought.
Indeed, CMS announced last month that the average premium is $32.50 each month, down from the earlier projection of $37 per month. Some plans would have a monthly premium under $20, the agency said.
According to the plan-provider list released Friday, only one plan – offered by Humana Insurance Co. – offers a plan that inexpensive. Furthermore, of the 23 plans available in Pennsylvania and West Virginia, 16 have a monthly premium ranging from $30 to $35, and the average premium is a $32.78.
Of particular concern, however, is the so-called "doughnut hole," or the $3,600 gap in coverage for which seniors themselves are responsible.
Under the new rules, Medicare plans take effect after a member has spent $250 on drugs in a particular year. From there, the plan pays 75 percent of costs until medicine expenses reach $2,250. Seniors are on their own until costs reach $5,850 dollars, after which Medicare pays 95 percent of drug bills.
A beneficiary could pay $3,850 each year for their medication. That’s excluding the cost of premiums and co-payments during the time Medicare is actually chipping in.
McClellan said Friday that options soon will be available through CMS for seniors struggling through the gap, but he did not elaborate.
The Social Security Administration announced Thursday that about 3 million people have applied for its low-income subsidy. The extra assistance will provide around $2,100 to low-income Medicare recipients, including partial cost of premiums, deductibles and co- payments, according to the SSA.
The doughnut hole is just one of many concerns about the plans.
Consumer protection agencies fear that allowing plan-provider representatives to cold-call seniors will make those seniors vulnerable to scams.
Last month, CMS issued rules for selling plans, including banning door-to-door sales and unsolicited e-mails. Moreover, sales representatives cannot ask for Social Security numbers or bank information, and, under federal law, can call only between 8 a.m. and 9 p.m.
To prevent graft and pocket padding, health-care providers can provide information on specific prescription plans and help beneficiaries choose the most beneficial plan, even if they have a financial interest in a particular plan. However, they cannot lead seniors to a plan for sheer monetary gain.
CMS plans to survey benefit recipients on their experiences choosing a plan, look into complaints and visit sites where seniors are being registered or given information. People wanting to report a sales company or other unsavory activity should call (800) MEDICARE.
Getting information to seniors also is a concern, particularly in rural areas such as West Virginia. In this state, local offices have tried to reach out through ads and call centers, in which beneficiaries can get an idea of the plans suiting their needs.
Help also can be had at West Virginia’s State Health Insurance Assistance Program by calling (877) 987-4463.
Next month, CMS will mail out a handbook and, soon after, have detailed drug-plan information available on its Web site – www.medicare.gov – or through the toll-free number.
McClellan, on Friday, urged people to begin discussing their Medicare plans as soon as possible.
"It’s time for those with Medicare and those who care about them to start making choices," he said. "We want them to have conversations about prescription drug plans."
To contact staff writer Morgan Kelly, use email or call 348- 1254.