AMWW#123: DON'T BE MEDISCARED BY NEW DRUG COVERAGE
Abe
by Abe Munder, the Wheeled Wonder
(AbeM...@aol.com)
Get set for dramatic reform of Medicare coverage in coming weeks. I
know the mention of Medicare makes eyes glaze over, so I'm saying up
top that this column's for retirees, those on disability or Medicaid,
and anyone else considering these in the next few years. Quick count
of heads . . . that leaves 43 million in the room. Good, let's begin.
Everyone here knows all about prescriptions. Now the politicians have
gotten wise, and from their heads sprang Medicare Part D: drug
coverage! Big stuff. Like all new programs, this one's a little bit
exciting and a little bit scary. We'll have more coverage, but also
more expense, more to keep tabs on, and more to learn.
Like the current prescription drug card program, we will have several
options in coverage. Here's why: the plan will be administered
through a number of private insurers. The responsibility is ours to
learn about them and decide which is best for our personal situations.
We are going to have to do some homework here.
Oh, did you forget there's a discount card benefit in place? You're
not alone. The policy is a bust, burdened with complications and
offering only marginal benefits. Medicare received only a handful of
takers, not the grateful multitudes they expected at the rollout. No
wonder. It's hard to sign on the dotted line when you don't know what
the heck you are signing. This experience may have soured the public
toward the upcoming program: a Gallup poll reported that 24 percent
said they'd apply for the new program, and a full 50 percent said they
wouldn't.
But the drug card program is only an appetizer, an interim measure, and
now comes the full-on meal. We'll hope this next one is clearer and
better. As usual, knowledge is the key. I'll go down a timeline, to
make it easy.
OCTOBER 13: On its website (http://www.medicare.gov), Medicare will
present comparisons of the competing drug benefit plans. You can also
call 800-MEDICARE (800-633-4227) to speak with a live operator. This
month, we will also receive the annual Medicare & You book that details
the new coverage.
There are already TV commercials. Did you see Carol Burnett? I love
Carol Burnett! My Oma and I would watch Mr. Tuddaball and Miss
Suewiggins on Saturday nights. Anyway, get ready for more commercials,
most without Carol Burnett. Then advertisements. Junk mail. Even
phone calls. (Careful with these--don't let them pressure you on the
phone for immediate commitments. This might be illegal, and you should
have the numbers before you, in any case.) Plus, more commercials.
Lots of money in play.
And lots of options, lots of numbers and paperwork to digest. But this
is no cause for complaint. The process might not be an easy one, but
this is real coverage. Find out the rules, and excel at them. If you
have difficulty sorting through the morass (I think I might), call a
family member to help you understand it, or call Medicare. They are
there, waiting for your calls.
If this turns out to be a mess, the kinks will be ironed out later.
The way politics are lately, the politicians are on a hair-trigger to
make this work. If you don't like something, make a phone call, write
a letter. You are in the driver's seat.
NOVEMBER 15: Plan enrollment begins. Those in Medicare Savings
Programs and Medicaid will also select a plan. You have 46 days before
the plan starts. You must keep your choice for an entire year before
another opportunity to switch plans. Those who do not select a plan,
will have one selected for them by the agency.
The insurers' plans will be competitive and offer differing benefits.
All are variations on a standard theme. The agency requires each one
to meet minimum levels of benefits, like covering all drugs for certain
conditions such as cancer and seizures, and offering at least two
treatment options for other conditions. On average, a plan will cover
89 of the 100 most widely used drugs. We'll also find differences in
premiums, deductibles, co-pays, and participating pharmacies. (For
instance, some plans will encourage you to order three-month supplies
through the mail, while others permit visits to your corner drugstore.)
Finally, different plans will be offered in different states.
Draw up a list of your drugs. Check your list against plan formularies
(the insurers' lists of eligible drugs). Plans may offer savings for
using generic drugs, so learn if generics are available to replace your
brand-name drugs, and if your doctors approve of them. Keep in mind
where you want to fill your prescriptions, and check which pharmacies
participate in each plan.
A program called Extra Help will bring Part D coverage to those who
can't afford monthly premium payments.
Finally, Medicare Advantage Plans (called Medicare Part C) will offer
HMO-type coverage in place of the old Medicare Plus Choice policies.
These plans feature an entirely different set of benefits from standard
Medicare. In general, they are cheaper and provide a broader range of
services, compared to Medicare parts A or B. On the other hand, they
impose their own restrictions, like on the number of times you can get
a certain treatment, and especially on which doctors and facilities you
may visit. But a Part C plan could make your life easier in other
ways: for example, many Medicare users will have to cut three separate
checks each month for parts A, B and D. Part C coverage simplifies
that into one. Plus, as an incentive to join, some Medicare Advantage
Plans will offer free Part D coverage.
JANUARY 1: Your new Medicare prescription drug coverage begins.
Here is a sample of basic Part D coverage. The numbers are totally
made up, but they'll give you an idea of what to expect.
-- You will have to pay a monthly premium. I've seen figures from
$1.87 to around $40, on top of what you already pay for Medicare Plan
B, supplemental plans, etc. That's quite a range, so I'm scratching my
head. No way to tell for sure until the exact details come out
November 15.
-- You will have a deductible to meet, at least in most plans. (Again,
November 15 will tell.) For example, on a $250 deductible, you pay for
the first $250 of prescriptions, before your coverage kicks in.
-- Some observers are calling this "doughnut hole" coverage, because of
the way the benefits are structured. There are tiers of coverage, with
a first tier where most of your costs are covered; a second tier where
you pay out of your own pocket; and a third tier where Medicare springs
for almost everything. Different plans will set different levels, but
here is an example:
AFTER you meet your deductible, you may pay 25 percent (Medicare pays
75 percent) of your drug costs between $250 and $2,250,
THEN you may pay 100 percent of your drug costs between $2,250 and
$5,100,
THEN you may pay only five percent (Medicare pays 95 percent) of all
drug costs above $5,100. Using my examples above, by the time you
reach the $5,100 threshold, you will have spent $3,600 of your own
money. That's $1,500 in benefits, and more if your yearly drug
expenses climb above $5,100 (which is only $225 per month--I think a
lot of people spend way more than that, and they will benefit most).
MAY 15: This is the deadline for selecting a plan without penalty. If
you enroll in the program after this date, you will be charged a
penalty each month that you carry the plan.
Despite the uncertainty, this is all good news for seniors and the
disabled. However, it could disappear before our eyes. With the
federal government running deeper and deeper in the red, especially
after the devastating storms, there are calls for Part D to be scaled
back. Medical costs skyrocket faster than other segments of the
economy, and meeting the prescription requirements of millions of
retirees is a huge commitment for the government--maybe too much so.
The overruns began immediately: the program was sold politically as a
$400 billion expense, yet two years later the costs have doubled, and
this before a single prescription has been filled. Some fiscal
conservatives and even moderates like presidential hopeful John McCain
are calling for cancellation of the plan altogether.
Make full use of the opportunity here.
On a side note, I visited a government website for details to pass to
you through this column. It was for CMS, the Centers for Medicare &
Medicaid Services. There I was to find a clickable map of the U.S.
that would tell me how many plans were available in each state. Except
. . . no map. Nowhere on the website. Uh-oh.
To join my mailing list, please write abem...@aol.com
or visit http://www.angrygimp.com
or http://members.aol.com/abemunder
1507