• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Seniors Have Time to Research Drug Benefit

Posted on: Monday, 10 October 2005, 18:00 CDT

By WINTHROP QUIGLEY Journal Staff Writer

EDITOR'S NOTE: Medicare beneficiaries will begin receiving a prescription drug benefit in 2006. This is the second story in the Journal's series designed to help seniors understand and take advantage of the new benefit.

It's time for Medicare beneficiaries to begin evaluating which of dozens of health plans offers the best prescription drug benefit.

The choice won't be easy. The federal Centers for Medicare and Medicaid Services, which administers Medicare, has authorized companies to offer 64 products in New Mexico that include some sort of drug benefit.

The very first thing to do is take your time, advised Buffie Saavedra of the state's Aging and Long-Term Services Department. Though the companies have begun marketing their products, recipients can't even begin to enroll for the benefit until Nov. 15. That gives seniors more than a month to do some research.

The Aging and Long-Term Services Department is ready to help with the research and answer questions. Its toll-free phone number is (800) 432-2080.

Congress enacted legislation in 2003 that allowed the government to help pay for drugs used by Medicare recipients for the first time since the program began 30 years ago. Instead of having the government cut a check to the recipient or pay a pharmacy or other provider for the drugs directly, the law authorized a variety of private companies to sell what are essentially insurance products to cover the drugs.

The operative word for most seniors is "sell." With the exception of low-income seniors, recipients can expect to pay a monthly premium for the benefit, copayments and deductibles, though there are some plans that offer zero deductibles if the senior wishes to pay a higher premium. More on that later.

A single beneficiary who makes $1,200 or less a month is considered low income. Those beneficiaries do not pay premiums or deductibles but must pay copayments for medicines.

Complicating matters further, two kinds of plans are available to seniors. Seniors can choose to take standard Medicare benefits and purchase a separate drug benefit, or they can buy a managed care plan that covers medical services, hospitalization and prescriptions.

Medicare benefits have been available through managed care plans for some time. They were called Medicare Plus Choice plans until Congress changed the name to Medicare Advantage plans.

The Medicare medical, hospital and drug benefits are paid and administered by the insurance company that offers the Medicare Advantage plan. In New Mexico, Blue Cross and Blue Shield, Humana Insurance Co., Lovelace Insurance Co., Lovelace Senior Plan, Presbyterian Health Plan Inc., Presbyterian Insurance Co. Inc., and United Healthcare Insurance Co. are offering Medicare Advantage plans.

If Medicare Advantage isn't for you, 17 companies offer a drug- only benefit. They are Aetna Life Insurance Co., Cigna HealthCare, Community Care Rx, Coventry AdvantraRx, HISC, Humana Inc., PacificCare Life and Health Insurance Co., Presbyterian Prescription Drug Plan, Prescription Pathway, SierraRx, SilverScript, Sterling Prescription Drug Plan, Unicare, United American Insurance Co., United Healthcare Insurance Co., WellCare, and YOURx PLAN.

The cost of these plans varies, but more importantly, Saavedra said, so do the drugs they cover. Not all medicines are part of the plans' formularies.

Another wrinkle: Not all pharmacies will accept all plans.

So research is essential. "What's good for your neighbor is not necessarily what's good for you," Saavedra said.

She recommends taking these steps before choosing a company for your drug benefit:

Get a complete list of all the drugs you take. Ask your physician's office and your pharmacy for help.

Ask them if there are alternatives to the drugs you are taking. A plan may not cover exactly what you use now, but it may cover a suitable alternative.

Determine which of the plans cover the drugs you are taking, or at least most of them.

Compare prices. Don't forget there are up to three costs you'll incur: the premium, the deductible and the copay. If you take a lot of drugs, you may want to pay a higher premium but no deductible. Some companies may offer more favorable copayments but less favorable premiums. Get all of the numbers before you decide.

If you care which pharmacy you use, ask which plans the pharmacy will accept.

Above all, don't rush.

One decision that should be easy, Saavedra said, is to drop Medigap Rx coverage. Medigap plans pick up costs that standard Medicare doesn't cover. Medigap Rx plans include drug coverage.

"The last thing I would advise anyone to do is stay in a current Medigap Rx plan," Saavedra said.

The reason is the cost. One company charges $400 a month for Medigap Rx but only $100 a month for a Medicare Advantage preferred provider plan that includes drug coverage, Saavedra said.

Medigap Rx plans can't sell to new customers after Jan. 1, which means that over time their pools of insured will shrink and grow sicker. That will drive premiums higher, Saavedra said.

As big a nuisance as the research might be, the cost of doing nothing is high. If you don't sign up and you don't have acceptable coverage from a source such as a pension plan -- Medigap Rx is not an acceptable alternative for the feds -- Uncle Sam will charge you an additional 1 percent of the base monthly premium for drug coverage for every month you're not enrolled. That extra premium applies for as long as you have Medicare drug coverage.

Source: Albuquerque Journal

More News in this Category