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Drug Plan Decision Time Nears

Posted on: Friday, 30 December 2005, 21:00 CST

By Annette Wells, San Bernardino County Sun, Calif.

Dec. 29--Medicare beneficiaries nationwide have until May 15 to enroll in a new prescription-drug plan, or pay a penalty if the decision comes later.

Dual beneficiaries of California's Medi-Cal program and Medicare don't have that luxury.

Their deadline to switch coverage is Saturday.

Under terms of the federal Medicare Modernization Act, if you qualify for both Medi-Cal and Medicare, Dec. 31 is your deadline to pick a plan or, come New Year's Day, the federal government will have chosen one for you.

This impacts about 1 million in California, according to the state Department of Health Services.

Lea Brooks, spokeswoman for the department, said that as of April, 45,934 people in San Bernardino County, 41,029 in Riverside County and 332,662 in Los Angeles County were covered under both health-care plans.

Medi-Cal is California's federal Medicaid program for the poor.

While automatic enrollment may offer some relief to those confused about Medicare Part D or too frail to call (800) 633-4227 or read the fine print at www.medicare.gov, the impact could mean higher costs or fewer options for drug coverage, some senior advocates say.

"I would never spend a penny on it," said Margaret Littrell, an 80-year-old San Bernardino resident and a member of the San Bernardino County Senior Affairs Commission. "But I'm blessed that I don't have to."

Littrell, who calls herself a "bleeding Republican," says the new law will only cost those with fixed incomes more money, and that the real solution is a universal health-care plan. Much to the chagrin of her political party, she is encouraging her friends who qualify not to sign up. Prior to Congress' passage of the Medicare Modernization Act in 2003, Medicare's role was to provide hospitalization and health-care benefits to low-income seniors and the disabled. It didn't provide prescription-drug coverage. However, in California, Medi-Cal paid the drug costs of those enrolled in both programs.

Though it is not a requirement to enroll in Medicare Part D, those who decide to do it at a later date will have to pay a 1 percent higher monthly premium for the months they didn't enroll.

For example, if a beneficiary waits six months past the initial enrollment period, the monthly premium will always be 6 percent more than what others who registered on time would pay.

Under the standard benefit, Medicare beneficiaries pay monthly premiums averaging about $32 and a yearly deductible of $250.

They also pay a portion of drug costs 25 percent until drug spending reaches $2,250. Beneficiaries then pay all drug costs until they hit $5,100, at which point they will pay 5 percent of any further charges.

Where it might become confusing is that no drug plan is the same and the options are plentiful.

Additionally, some drugs covered under one plan may not be covered under another. And individuals will have to repeat the enrollment process annually. For seniors and the disabled, this could be a challenge.

"We're dealing with people who are already frail and have a difficult time using the phone system because they can't hear or don't understand what button to push and aren't Internet savvy. We're very concerned," said Mary Kitayama, program coordinator for the Jocelyn Senior Center in Claremont.

For most of this year, the center has held informational meetings outlining what the Medicare Modernization Act means and how it will impact the lives of seniors.

Like most senior centers, officials from social services, pharmacies and health-maintenance organizations have been invited to speak to seniors about the upcoming changes, Kitayama said.

"We're fielding as many calls as we can and we're encouraging Claremont residents to call us with their questions," she said.

"We will continue with this all the way until the end but, I will tell you, I've been through training for Part D four times now, and I still don't understand most of it."

In addition, local agencies and insurance plans are offering educational services to Medicare beneficiaries about the changes.

Earlier this month, Secure Horizons, a Medicare Advantage health-care plan offered by PacifiCare, held a town hall meeting at the Hilton San Bernardino about Part D.

Approximately 147,000 residents of San Bernardino, Riverside and Los Angeles counties hold policies under Secure Horizons Medicare Advantage program. The program offers complete medical care and drug coverage.

Cheryl Randolph, a spokeswoman for the company, said people enrolled in its Medicare health plan don't have to do anything.

"If they like what they have, they don't," she said. "They will automatically be enrolled in Secure Horizons' Part D program. What's happening now is that Medicare will start reimbursing us for prescription-drug coverage of our members."

No matter what people's feelings are about Medicare's new job, state health officials are encouraging the eligible to sign up as soon as possible to avoid any disturbances in care.

Brooks said anyone with questions should call Medicare or their health-plans provider.

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Copyright (c) 2005, San Bernardino County Sun, Calif.

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Source: San Bernardino County Sun

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