Part D Drug Plan Intro

Good News on Medicare Part D: There Is Still Time to Enroll Posted on Wednesday, February 01, 2006

By Wendy J. Meyeroff THE ERICKSON TRIBUNE If confusion has kept you from enrolling in a Medicare Part D Prescription Drug Plan (PDP), you’re not alone. That confusion was recently typified at a Part D seminar given by Pat Venable of the Baltimore County Department of Aging. Ms. Venable spoke at Oak Crest, a community in Parkville, Md., built and managed by Erickson.

One adult child who had learned to navigate the drug lists said she was going to spend that weekend going through it with her mother. Suddenly a voice called out in the auditorium, “Can I be your mother, too?”

Information Overload Annarose Bowers, an Oak Crest resident, told The Erickson Tribune she had done her own research but came to the session for clarification. “There are too many plans. It’s hard to get information,” she said.

Many attendees at Oak Crest wished the government had limited plan options to 20 or less, instead of simply inviting competition from all comers.

“While throwing open plan development to private industry offers competitive pricing, it has the disadvantage of creating too many options. Beneficiaries are exhibiting the ‘deer in the headlights’ syndrome. They have so much information, they don’t know which way to turn,” says Bruce Sturm, senior vice president, Erickson AdvantageSM. “Part D is the biggest improvement to Medicare since that program was created in 1965,” says Sturm. Venable agreed, noting, “With Part D, older Americans have the government’s assurance that once their prescription drug costs for the year exceed $3,600 out-of-pocket, for the remainder of the year they will only pay 5 percent of their drug costs. That sounds like a lot, but if you need cancer-fighting medicines costing a total of $10,000, you will save a significant amount.”

There’s Still Time Both Venable and Sturm agree if you are a government employee you probably have a good health plan, including prescriptions, and don’t have to make any changes. For

other people, there’s still good news: you can join a PDP without penalty until May 15.

After that, you add 1 percent a month to your premium for every month you wait to enroll after May 15, 2006. “If Mrs. Jones enrolls before the May 15 deadline, she would pay a $30 monthly premium for her prescription drug coverage. She’s fairly healthy, so she decides not to enroll and ‘save’ the $30 a month. “But in 2010, Mrs. Jones is ill and needs a PDP. By now, the premium is $50, but Mrs. Jones has to add a 1 percent increase per month for delaying enrollment. That means her monthly premiums cost $80, not $50. That $30 monthly can mean a lot if you’re on a fixed income,” says Venable.

But officials say some state plans can mitigate your expenses. “There’s a plan in Maryland that has a monthly premium as low as $6.44,” says Venable.

Finding the Right PDP Choosing a PDP that’s right for you starts with making a list of your medications (see illustration on p.8). Medicare offers two ways to determine which plans cover any or all of your medicines. You can go to its website, www.medicare.gov, and follow the simple instructions, using the “Formulary Finder” to enter your medications. When your entries are completed, the system will find which health plan(s) cover all or the majority of your medicines.

If you do not have or use a computer, ask family or friends to help you. Otherwise, call Medicare at 1-800-Medicare, 24 hours a day, 7 days a week. Give them your drug list and they will help you find a plan.

What if a plan covers everything but the drug you are most concerned about? “Let’s say a plan doesn’t cover Lipitor for your cholesterol. It should tell you which alternatives it provides— like a generic, or another brand name, like Zocor,” said Venable.

Then you can do three things: “See if you can find a plan that covers Lipitor, ask your doctor if Zocor or the generic is a viable option, or ask your doctor to write an ‘exemption to the formulary’ which could get the first plan to cover Lipitor for you,” she says.

What Are Your Other Health Concerns?

Remember, Part D only covers prescription medications. You still need coverage for your doctor and hospital bills. That might mean a “Medigap” plan to cover your first $952 in Medicare Part A hospital expenses and then another plan for Part D coverage.

James Whynot, M.D., is the medical director of Brooksby Village, a community in Peabody, Mass., built and managed by Erickson. “We put together a worksheet for our residents which not only focuses on their medications, but also asks them what hospitals they go to and if their specialists are in a company’s network. You have to analyze all your costs. If you’re going to save $500 on medicines, but spend $10,000 because your doctors aren’t covered, that’s obviously no bargain,” he says.

“A Medicare Advantage Prescription Drug Plan (MA-PD) is a complete plan and includes drug coverage,” says Sturm. So far there are only four major MA-PDs: Aetna, Kaiser, Eldercare, and Erickson Advantage SM. Erickson AdvantageSM is available to residents of Erickson-built and –managed communities in Maryland, Virginia, Massachusetts, New Jersey, and Pennsylvania.

“Erickson AdvantageSM offers another benefit: we have eliminated many up front costs you would have to pay with other programs, such as the $250 deductible for your medications.”

Get Help!

Dr. Whynot admits most physicians are probably not your best resource through this maze. “The average doctor now spends 7 minutes with a patient, as opposed to Erickson HealthSM physicians who average 25 minutes. I personally have spent at least 30 minutes with my patients on this and sometimes that’s still only scratching the surface. Besides, many doctors are themselves confused,” he says.

Sturm urges people with access to Erickson Advantage SM to “sit down with an Erickson AdvantageSM representative. They will walk you through the process and help you determine which program is best for you, even if it’s not Erickson AdvantageSM.” If you don’t have Erickson AdvantageSM and you haven’t found help through Medicare, check with your local Department of Aging or Social Security office.

Be Careful, But Get Started Be careful. Officials are already seeing scams targeting the 2.4 million retirees who fall into the “donut hole” of Part D: those whose medicines fall between $2,250 and $5,100 and have to pay totally outof- pocket. These schemes generally promise some coverage for a “small” fee.

“Never give your Social Security number, bank account, or credit card numbers to anyone. Any ‘expert’ who says they need these to help you should be avoided—and reported,” warns Venable.

“I honestly believe the worst thing a beneficiary can do is nothing. Everyone is scared to make a decision, but the least acceptable thing you can do is not do something. Remember, if you don’t get into the best plan in 2006, at least you’re in something to help you avoid those penalties. You can always change plans when open enrollment begins for 2007 later this year,” says Sturm.