Facing Dozens of Plans, Royal Oak Woman Wants Answers

By Susan Tompor, Detroit Free Press

Nov. 14–Marcia Weiner knows she’d like to sign up for Medicare’s new prescription drug coverage. But she won’t be doing it Tuesday.

The 73-year-old Royal Oak retiree still has to get answers to lots of questions.

Right now, she has no idea how to pick the plan that will work best for her out of the dozens of plans being offered in Michigan.

But she knows she needs to do something.

“I have no prescription drug coverage,” she said. And she’s been spending nearly $2,800 a year on prescriptions.

Her husband, Lester Weiner, 78, owned and ran Teck Cleaners in Oak Park for 40 years. Marcia worked part time in the plant. But they sold that business 12 years ago.

“We’re completely retired,” Marcia said.

They live in a Michigan apartment half of the year and a Florida condo the other half. They spend more than $50,000 a year in retirement, using money from Social Security and their investments. They don’t have a pension.

Lester doesn’t have to worry about prescription drug coverage. He served in the Navy during World War II and he gets his medication from the Department of Veterans Affairs, he said.

He takes seven prescription drugs, including Coumadin, which is a blood thinner, and Actos, which helps control blood sugar.

But thanks to drug coverage through the VA, he usually pays $7 a drug for a three-month supply.

Marcia Weiner has been spending about $233 a month for five drugs: Lipitor, which treats high cholesterol; Fosamax, which treats osteoporosis; folic acid; Hydrochlorothiaz, which treats hypertension, or high blood pressure, and Lotensin, another blood pressure drug.

Her doctor recently took her off Lotensin. So now, she needs to find a Medicare plan that would cover the four drugs.

“Hopefully, I won’t be taking any more, but you never know,” she said.

She had been buying some prescription drugs from Canada through the mail over the years.

But she said that’s not much of an option now. U.S. officials have been trying to crack down on across-the-border prescription drug sales via mail order.

And under the new Medicare plan, prescription drugs purchased outside the United States will not count toward the Medicare prescription drug deductible. And that’s important to understand.

Many plans start out with a $250 deductible in which the consumer must pay 100% of the drug costs.

And after you’ve paid that deductible, the plan would cover 75% — or up to $1,500 — of the next $2,000 of drug costs. The consumer would pay the remaining 25%, or up to $500.

Minding the gap

But under many plans, consumers would face a coverage gap, known as the “doughnut hole,” where consumers must pay additional out-of-pocket costs.

Consumers could pay up to an extra $2,850 before Medicare’s coverage continues. While you’re in this coverage gap, the plan pays nothing toward your costs.

Consumers who have a very limited income and qualify for an Extra Help program would not face the coverage gap. Or consumers who buy a higher premium plan also can avoid the coverage gap.

If you have drug expenses that exceed $5,100, the plan covers up to 95% of the rest of your prescription costs until the end of the calendar year. You would pay 5% during that time.

That is called the catastrophic benefit and there’s no limit on that coverage.

The out-of-pocket maximum is $3,600.

But drugs bought from Canada or any foreign country do not count toward reaching that maximum cost.

Marcia Weiner wants to sign up for a plan in the next few weeks so she can get coverage beginning in January. And she wants a drug plan that can be used at drugstores in Michigan and Florida.

Weiner — who has already attended two seminars on the new Medicare drug plan — knows she’s got plenty of work ahead of her.

The Weiners don’t have a computer. But Marcia may get computer help from friends or other Medicare-related programs.

“I do everything by phone or legwork,” she said.

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