Take Your Time on Medicare Drug Decision

By Betty Booker

Take a deep breath, folks, and stop worrying: You don’t have to sign up for the new Medicare Part D prescription drug coverage on Nov. 15. This is an important decision.

“There is no need to rush!” says Jay W. DeBoer, commissioner of the Virginia Department for the Aging.

You have until the end of the year to enroll if you want to get drug coverage by Jan. 1, the first day the program begins, and you have until May 15 to enroll without a penalty.

“Don’t be pressured into any decisions,” DeBoer warns.

In the meantime, get ready to enroll: Gather all your prescription drug information. List all of your medicines, dosages and monthly cost. For example, levoxyl, 88 mcg, cost $2.88 a month, or $34.56 a year.

If you have health or prescription drug coverage, figure out what your current policies cover and how much the annual premium, deductible and drug co-pays cost you.

“If a beneficiary has employer retiree coverage, determine what is covered, whether the coverage will continue and any announced or likely cost increases,” DeBoer continues.

Your insurer is supposed to notify you by mail by Nov. 15 if your retiree coverage is “credible,” which means it’s as good as or better than the Medicare drug plan. If you don’t get such a letter or have lost it, call the plan administrator and ask for one.

Then keep that letter in your permanent files, says the Medicare Rx Education Network, which represents some 70 groups that include pharmaceuticals, insurers and nonprofit organizations.

DeBoer, a lawyer, says, “If a beneficiary currently has private pay prescription drug coverage” — for example, through an employer group or a Medigap policy — “schedule an appointment to talk to your agent or benefits administrator about your current coverage and what your current provider will offer.”

If your retiree coverage is discontinued later, you’ll have 63 days after your current plan ends to enroll in Medicare Part D without a penalty.

Let’s clear up a common misconception, noted last week at a Kaiser Family Foundation teleconference on Part D hosted by Trudy Lieberman, director of the Center for Consumer Health Choices at Consumers Union and president of the Association of Health Care Journalists:

Every Medicare beneficiary on Medicare Part A (hospital) and/or Part B (doctors’ visits) — regardless of income — is eligible for the prescription drug plan. You don’t have to be poor.

There is a minimum standard benefit that many plans will offer in 2006. Under it, you pay the first $250 of covered drug expenses (the deductible) and 25 percent of the next $2,000. You pay all of the next $2,850, but if your bills reach $5,100, Medicare pays about 95 percent of the rest of your covered drug bills for that year. You also pay a monthly premium for the standard plan.

Some companies have lowered or eliminated premiums, deductibles and some co-pays, so those costs vary by company. Shop, but be sure your drugs are covered by the plan you choose.

There is an additional drug program to help lower-income people on Medicare, called “extra help.”

The easiest way to find out whether you qualify for it is to visit www.socialsecurity.gov, click on New Medicare Prescription Drug Plan, then “apply for help” and answer a few questions about your income. Social Security will mail you a form. Call (800) 772- 1312 from 7 a.m. to 7 p.m. on weekdays.

People who get both Medicare and Medicaid, the state-federal health insurance for the poor, will be automatically enrolled in Part D for their drug coverage.

Everybody else has to sign up or they won’t be enrolled.