Morris News Service
The new voluntary Medicare prescription drug plan (known as Part D) can be confusing.
A recent study by the Kaiser Family Foundation showed that only one-third of seniors said they understand the drug plan well enough to know whether it would benefit them.
To try to clear up some of the confusion, the following information is provided to guide seniors through the Medicare maze:
Medicare beneficiaries can begin enrolling in the plan on Nov. 15 and start receiving benefits on Jan. 1. Seniors with limited incomes and resources can apply for additional help now.
Medicare participants will have several plan choices and should choose the one that best fits their needs. Beneficiaries can expect to receive mailings and telephone calls from private insurance carriers touting their individual plans.
Experts advise against choosing the first drug plan that comes along. Know your needs and compare them to available plans before choosing the one that's right for you.
Questions and answers about Medicare Part D:
Q: Do I have to participate?
A: The program is voluntary, but individuals who don't sign up when they are first eligible will have to pay a penalty (a higher monthly premium) if they change their minds later. If you have good drug coverage under another plan, you may not need to sign up. All Medicare beneficiaries are encouraged to comparison shop.
Q: Who is eligible to
A: Every Medicare beneficiary is entitled to drug coverage, regardless of age, annual income or health status. Those signing up for Medicare for the first time will be able to select a drug plan at enrollment.
Q: What do I have to do to get benefits?
A: Anyone who wants drug coverage must sign up for one of the Medicare-approved private insurance plans.
Q: When can I sign up?
A: Open enrollment begins Nov. 15 and runs to May 15, 2006. For your coverage to begin on Jan. 1, you will have to sign up by Dec. 31. If you sign up between Jan. 1 and May 15, 2006, your coverage starts the first day of the month after you enroll.
Q: How many of the private insurance plans will I have to choose from?
A: According to AARP, everyone will have at least two plans to choose from, although in some areas, there will be many more options. The plans are expected to charge different premiums and co-pays. Both brand name and generic drugs will be covered, and plans must cover at least two drugs in each class used to treat the same condition, but they won't cover all drugs.
Participants will be able to switch drug plans during an open enrollment period each November beginning in 2006.
Q: How will I know which plans are Medicare-approved?
A: Drug plans are listed by state at www.medicare.gov. The Centers for Medicare and Medicaid Services will send you the booklet, "Medicare and You," which should include information about all the plans available in your area. Beneficiaries will be able to compare the details of the various plans before they enroll.
Medicare Today said as many as 18 different plans could be offered.
Q: How will I know which plan to choose?
A: Beneficiaries will need to study and compare all the plans before they select one. All the plans are private, and each one will be slightly different. Not every drug will be available under every plan, and each plan will have its own list of discounted drugs.
Companies began marketing and selling their plans on Oct. 1. Those plans include information about costs, covered drugs and participating pharmacies.
Medicare Today suggests there are several things seniors can do right now to help them choose a plan including:
Make a list of all the drugs and dosages you take, including how much you spend on each drug; gather the names and contact information of your pharmacist, physician and anyone else who can help answer questions about your medication needs; and
find someone to help you shop the plans. You might get help from family members, neighbors, friends or your pharmacist. Churches and senior citizens groups may offer assistance in some communities.
You also will be able to compare plans by going to www.medicare.gov or www.medicaretoday.org. You may also receive help by calling 800-633-4227 or 866-723-0416 after Oct. 13.
AARP has prepared a booklet, "The New Medicare Prescription Drug Coverage: What You Need to Know," which is available by calling 888-687-2277. Some area pharmacies have free Medicare Part D pamphlets and booklets available to their customers.
Q: How much are monthly premiums?
A: Although much of the cost is paid by the government, most participants will pay a portion. The national average is predicted to be $32.20 per month, although some plans are expected to have premiums below $20 a month. Each person must pay an individual premium as there are no discounts for married couples.
Low income seniors who qualify for extra financial help will pay no premiums or deductibles.
Q: Can premiums be deducted from my Social Security check?
Q: What else will I have to pay?
A: Typically, each enrollee will pay a $250 deductible and 25 percent of the next $2,000 worth of drugs. After that, Medicare stops paying anything, unless an individual's total drug cost reaches $5,100. At that point, Medicare will pay 95 percent of all other costs during the calendar year.
Some plans will offer lower deductibles, and other plans will offer coverage in addition to the basic Medicare drug benefit.
Those with limited incomes will have smaller co-pays, and many will not be required to pay a deductible.
Q: What if I already have prescription drug coverage with an insurance plan or a former employer?
A: Your current plan may be as good as the new Medicare coverage. If so, you can join a Medicare plan at a later date without a penalty. You should be getting information from your current provider about how that plan will dovetail with the Medicare drug coverage plan.
Q: Is there additional help for people with limited incomes?
A: Yes. Those with annual incomes less than $14,355 (for a single person) or $19,245 (for a couple) may be eligible for additional help in paying their premiums and co-pays. Earlier this year, the Social Security Administration mailed applications to individuals if believed might qualify. Others, who receive Medicaid or Supplemental Security Income payments, have been automatically enrolled. But many individuals with limited incomes will need to apply for assistance.
If you received an application form, fill it out and return it. If you did not receive one and believe you might qualify for additional assistance, call 800-772-1213. Even if you have been approved for extra help, you still need to sign up for one of the Medicare-approved drug plans.
Q: How can I keep from being the victim of a scam?
A: All the Medicare-approved companies will be marketing their plans over the telephone and by mail, but not door to door.
If someone shows up at your door pretending to be representing a drug plan sponsor, don't give them any financial information and call the police.