Medicare Prescription Drug Plan Explained At Senior Center Seminar

By Nancy K. Crevier

In an effort to provide information concerning the Medicare Prescription Drug Plan Part D in which senior citizens will be eligible to enroll between November 15, 2005, and May 15, 2006, Newtown Senior Center hosted Eric Freedman of the Western Connecticut Area Agency on Aging (WCAAA) on Wednesday, August 24. Mr Freedman addressed a standing-room-only crowd of more than 100 seniors, simplifying data provided to the group, and answering questions about the voluntary drug program.

The Medicare Prescription Drug Plan Part D will provide partial payment for prescription drugs. Presently, Medicare covers only prescription medicines received in a hospital or in a doctor’s office, and in a very limited number of other instances. Medigap insurance must be purchased to cover other prescription expenses.

What seniors must discern is whether it is to their advantage to sign up for Part D.

Medicare Prescription Drug Plan Part D, which takes effect January 1, 2006, requires a monthly premium, paid to a private plan, of approximately $32 per month. That is followed by an initial deductible of $250, and a second, larger deductible. Yearly prescription costs between $250 to $2,250 will cost participants in Part D another $500, with Medicare picking up the remaining $1,750. Prescription costs between $2,250 and $5,100 require another $2,850 out-of-pocket payment. When once yearly prescription costs exceed $5,100, Medicare will pick up 95 cents of each dollar. For seniors who are now paying for large quantities of expensive drugs every year, the plan could be to their advantage, despite the premium costs and deductibles.

Part D does not cover drugs from Canada or anywhere else, Mr Freedman explained, and enrollment in the plan is not automatic. “If you don’t sign up, you won’t be in it.” After the initial enrollment period, a substantial penalty will be applied for those who want to join later. A one percent yearly premium for each month seniors were eligible to join, but did not, will be assessed. “That’s for life,” stressed Mr Freedman. “That’s 12 percent a year.”

For example, he said, “If you join in January of 2007, there will be a 12 percent penalty each year. If you join in January of 2008, there is a 24 percent penalty each year, every year after that.” However, he went on, as distressed murmurs ran through the crowd, “No penalty will be applied if adequate private coverage you now have drops your prescription plan and you want to join.” A six-week enrollment period in November and December of each year will allow for new participation without penalty, as well.

Seniors expressed concern that they would not know if their present coverage was comparable to the proposed Part D.

“If you already have drug coverage that is better than or equal to the new Medicare, don’t worry,” Mr Freedman assured the group. “Your plan administrator will tell you, by law, by the end of September [if your plan is equal].” Veterans and those with TRICARE also do not have to be concerned. Clients of ConnPACE, a state programs that provides coverage for part of prescription costs, will be covered by the new plan, as ConnPACE will wrap around the new Medicare drug plan. ConnPACE will pay the premium and deductibles.

 

Available Drug Plans

In mid-October, said Mr Freedman, seniors should receive a mailing that will explain the various private drug plans available in this area. “Ask yourself ‘Which plan is for me? Does it cover every drug I take? Does it include the drugs I pay the most for?’” he suggested. Seniors also have to be aware that the private plans that contract with Medicare do not have to cover every drug in a category. Medicare sets certain minimum standards for the private companies, and the plans must offer two drugs in each category, but specific drugs are not required.

If a participant chooses a plan based on the prescriptions they are presently taking, asked an audience member, and then the doctor changes the drug to one not covered by that plan, can a new plan be adopted? The answer is “no,” according to Mr Freedman, not until November of that year. For drugs that are not on any plan, a participant is “really out of luck,” he said.

There is an appeal process if the plan drops a drug while you are a participant, but it is a very difficult process to pursue, he explained. “During the process, you pay for the drug.”

In assessing the new plan’s desirability, one member of the audience suggested to the others that while Part D may not be a good investment now, “You might want to look down the line. Will you always be so lucky?”

Dawn McCary of WCAAA will be at the Senior Center on Tuesday, November 29, from 1 pm on, by appointment only, to enroll seniors in the Part D program. Call the Senior Center at 270-4310 to make an appointment. Seniors may also see Ann Piccini at Newtown Social Services, 3 Main Street, for applications.

For those seeking further clarification about the Medicare plan, or were unable to attend the Senior Center session, another informational seminar will take place September 22 at Nunnawauk Meadows at 1 pm. Registration is requested by calling 426-0659.

“We don’t know everything yet [about Part D],” Mr Freedman said, in wrapping up his talk. “This is a ‘shakedown cruise.’ We’ll have to see how it shakes out.”