State’s 51 Prescription Drug Options Target More Plans In Gap

By John Voket

If you are satisfied using the new Medicare prescription drug plan, the worst thing you can do is assume any letters coming from your provider can be ignored. According to Newtown Social Services staff members, who assist local seniors in subscribing to the program, there are numerous changes that are occurring to existing plans of which participants will want to be aware.

“Don’t ignore any letters you get from the plan, even if you think you won’t want to make changes,” said Social Services case manager JoAnne Klopfenstein. “Those changes they may be occurring whether you want them or not. Don’t assume the 2007 program will be exactly the same.”

Ms Klopfenstein and Social Services Director Ann Piccini both attended a Medicare plan update meeting Monday at the regional Area Agency on Aging. They learned about changes coming to Medicare drug plan subscribers in 2007.

And while some plans will require no action upon renewal, the renewal may come with changes to deductibles, the types of drugs covered, and the basic cost of the plan itself.

“The overall cost of the standard benefit has gone up,” Ms Klopfenstein said.

According to the local Social Services representative, the drug plan’s basic deductible went up, to $265 from $250; the initial benefit period went up — instead of the subscriber paying 25 percent of the first $2,000 in benefits, they will now pay 25 percent of $2,135; and the “donut hole” went up, from $2,250 to $2,400.

Ms Klopfenstein said more companies are covering in the gap, but more companies are only covering generics.

“If you had a plan that covered preferred and generics, you need to check before an automatic renewal goes into effect on the same plan to be sure preferred drugs are not removed,” she said. “A lot of things have changed so anyone on the plan needs to check the notification letter carefully. Residents can call us to get particulars.”

On November 30 the Medicare information bus is scheduled to arrive at the Newtown Senior Center, with staff and information to also assist interested subscribers and those looking to join the Medicare prescription plan.

A government release issued this week said seniors and people with disabilities who are satisfied with their current Medicare prescription drug coverage will not have to take any action when the Medicare Open Enrollment period begins November 15, but those who wish to make a change may find new options with lower costs and more comprehensive coverage available for 2007.

According to Centers for Medicare & Medicaid Services, surveys consistently show more than 80 percent of Medicare beneficiaries are satisfied with their current coverage and drug plans. As a result of the Medicare prescription drug benefit, more than 38 million seniors and people with disabilities now have some form of drug coverage.

The monthly premium beneficiaries will pay in 2007 will average $24 if they stay in their current plan, about the same as in 2006. While some people will see an increase in their current plan premiums, they have the option to switch plans.

Nationally, 83 percent of beneficiaries will have access to plans with premiums lower than they are paying this year and beneficiaries will also have access to plans with premiums of less than $20 a month.

Increasing Drug Options

Beneficiaries will have more plan options that offer enhanced coverage, including zero deductibles and coverage in the gap for both generics and preferred brand name drugs. Plans are adding drugs to their formularies.

Nationwide the average number of drugs included on a plan formulary will increase by approximately 13 percent, and plans will also use utilization management tools at a lower rate.

“The Medicare prescription drug benefit, passed by Congress and signed into law by the President, is saving seniors an average of $1,200 a year, and it just keeps getting better,” Health and Human Services Secretary Mike Leavitt said. “In 2007, there will be more plans with coverage in the gap, more drugs covered, and more help from Medicare in choosing the plan that’s best for you.”

During the 2007 bidding process, strong competitive pressure resulted in bids (costs of coverage) that average ten percent less than in 2006. According to guidance from the Centers for Medicare & Medicaid Services (CMS), each drug plan or health plan needed to show meaningful variation in their plan choices, including only two basic coverage options per region.

CMS also encouraged plans to offer a third option only if it included enhanced benefits, such as providing coverage in the coverage gap (“donut hole”) or covering excluded drugs.

In Connecticut, nearly all beneficiaries enrolled in Medicare prescription drug plans will be able to remain in the plan in which they enrolled for 2006 since almost all Part D sponsors are either continuing their current plans in 2007 or streamlining and consolidating their 2006 plans.

Particpants will be able to choose from 25 plans that offer enhanced benefits or services, such as coverage in the gap and little or no deductible. This represents an increase of six more choices of enhanced plans than in 2006. 

There are 31 plans that have zero deductibles, some of which also offer other enhanced benefits.  The lowest premium in Connecticut is $13.40, and three plans have a premium below $20 a month. 

With these options, 80 percent of beneficiaries in Connecticut have access to coverage with a lower premium than they are paying in 2006.  There are also options that cover generics and preferred brand name drugs through the coverage gap for as low as $39.80, and generally for under $50.

Beneficiaries with limited incomes who qualify for the extra help will have a range of options available for comprehensive coverage.  Beneficiaries who qualify for the full Medicare subsidy will pay no premiums or deductibles in these plans. 

In Connecticut, 100 percent of low-income beneficiaries will not need to change plans to continue to receive this coverage for a zero premium.

There are eight new national organizations offering drug plans to beneficiaries, in addition to the nine national plans that were available in 2006.  The list of national plans can be found at www.medicare.gov/medicarereform/local-plans-2007.asp.

Medicare Advantage Access

In general, beneficiaries in Connecticut will also have greater access to Medicare Advantage health plans next year, generally with lower costs for drug coverage. These plans offer an opportunity for additional benefits beyond those covered in the original Medicare program, with savings that average around $82 a month nationally for hospital and physician benefits. 

In addition to these savings, Medicare Advantage plans provide overall care coordination, and more effective use of drugs that lead to savings in other health care costs. As a result, the cost of drug coverage in Medicare Advantage plans is about $6 a month lower on average nationally in 2007 than in 2006. 

Connecticut will also have at least one Medicare Advantage plan that provides basic drug coverage for $0, and will also have at least one Medicare Advantage plan that provides coverage in the gap for $0.

In addition to prescription drug plans, Medicare beneficiaries in Connecticut will have access to the first Medical Savings Account plans and related consumer-directed plans ever available in Medicare.  These plans provide Medicare beneficiaries with more control over their health care utilization and health care costs, while providing them with important coverage against catastrophic health care costs.

Beneficiaries who want to consider other options will have access to help from many sources in the fall including:

éA notice of any coverage changes from their drug plan, coming at the end of October;

éThe enhanced Medicare Drug Plan Finder will be  available in mid-October;

é800-Medicare (800-633-4227), which will be available 24/7;

éThe Medicare & You 2007 handbook, the annual handbook that explains Medicare coverage, which beneficiaries will receive in October; and

éLocal organizations such as the State Health Insurance Assistance Programs (SHIPs) and thousands of other Medicare partner organizations that will provide personalized assistance throughout the fall.

Ms Klopfenstein said that if an individual qualified for the plan in 2006, he/she can minimize his/her lifetime penalty by signing up in 2007, even if the benefit is not currently needed.

“Eligible Newtown residents should sign up November 15 through December 31,” she said. “If you didn’t sign up by May 15, 2006, you’ll pay a penalty from June 1 to December 31 of approximately $1.91 above the monthly premium for the rest of your life.”