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New Year's Day May Be Chaotic at Pharmacies: NEW MEDICARE DRUG PROGRAM WILL BEGIN

Posted on: Saturday, 31 December 2005, 15:00 CST

By Barbara Feder Ostrov, San Jose Mercury News, Calif., San Jose Mercury News, Calif.

Dec. 31--Pharmacists are dreading New Year's Day, the first day of the new Medicare drug program. For the first time in its 40-year history, Medicare will help pay for seniors' prescription drugs.

Millions of Americans have enrolled in government-approved Medicare prescription drug plans, or already have supplemental coverage that provides prescription help.

But enrollment has been confusing and complicated. Pharmacists predict long lines in early 2006, as they sort out patient records and field questions from befuddled patients.

"I'm expecting chaos," says pharmacist Thomas Lai, co-owner of Disco Rex Pharmacy in Palo Alto. "We know so little, and so many people are switching at once."

Lai advises patients to bring their new insurance cards, Medicare cards -- and Medi-Cal cards if they are also Medi-Cal recipients.

Here are some questions and answers regarding the new benefit, compiled from the U.S. Centers for Medicare and Medicaid Services, UnitedHealth Group and other sources:

Q What is happening on Jan. 1?

A If you have enrolled in one of the new Medicare prescription drug plans, Medicare will help pay for your drugs starting New Year's Day. Patients have until May 15 to enroll in a prescription drug plan, but will face financial penalties after that. Patients who are on Medi-Cal (or Medicaid in other states) and Medicare have been switched into Medicare drug plans. Starting Jan. 1, Medi-Cal will no longer pay for their prescriptions.

Q Is it too late to enroll in a Medicare prescription drug plan?

A No. Enrollment started Nov. 15, but patients have until May 15 to choose a plan without financial penalties.

Q What if I need a prescription filled and I don't have an ID card from my new insurance plan?

A You should receive an acknowledgment or confirmation letter about a week after you enroll, and an ID card three to five weeks later. If you don't have your ID card yet, bring the letter from your plan, your Medicare card and a photo ID.

Medi-Cal patients should also bring their Medicaid cards. Save the receipts from your pharmacist, too.

Q What if my pharmacy can't fill my prescription on Jan. 1?

A Your pharmacist may be able to confirm your enrollment in a prescription drug plan by checking a computerized database or calling your insurer. In some cases, you may have to pay cash for your prescription, then file a claim for reimbursement from your Medicare drug plan. If you also qualify for Medi-Cal, your pharmacist may be able to enroll you in a backup drug plan so you can get your prescription immediately. Some pharmacists, like Lai, say they'll fill the prescription even if there are glitches and resolve the problems later.

Q What if I am on Medicare and Medi-Cal?

A Starting Jan. 1, Medicaid will no longer pay for your drugs, except in limited cases. You should have been automatically enrolled in a new Medicare prescription drug plan this fall and may already have received your identification card. You may change your plan if the one you were assigned does not cover your medications or otherwise meet your needs.

Q Where can I get more information?

A Call (800) MEDICARE or visit www.medicare.gov. The independent Health Insurance Counseling and Advocacy Program provides free counseling for Medicare recipients; call (800) 434-0222.

Contact Barbara Feder Ostrov at bfeder@mercurynews.com or (408) 920-5064.

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Copyright (c) 2005, San Jose Mercury News, Calif.

Distributed by Knight Ridder/Tribune Business News.

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Source: San Jose Mercury News

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