Archive for Saturday, November 5, 2005

Medicare Part D prompts questions

November 5, 2005


Q: I caught part of your recent radio program with Medicare representatives about Medicare Part D. I found it to be most informative, but missed several of the important parts. Is there a way I can get a copy of the program, and can you summarize it?

A: Because we have received quite a few questions about Medicare Part D (which seems to be confusing a lot of folks), and because enrollment in the program begins Nov. 15, we moved your question to the top of the list.

Medicare Part D is a prescription drug benefit available to all 42 million Americans who receive Medicare Parts A and B. All Medicare Part D plans have been developed by private companies and submitted to Medicare for approval.

Each state will have a number of official plans that should have the "Medicare Approved" seal on their materials. If the materials don't have this seal, don't buy it. Instead, report to Medicare that people are trying to sell you a bogus plan.

While Medicare personnel cannot sell or endorse any plan, they are available to answer questions at (800) 772-1213. You also can get information at local senior agencies in your area, but be forewarned that the burden is on you to review the plans and make the choices that best fit your needs.

Make the call

For your protection, approved Medicare Part D drug plans are not allowed to be sold via telemarketing - i.e., the salespeople can't call you and enroll you over the phone. The only way you can enroll in an approved Medicare Part D drug plan by phone is by you placing the call to them.

Of course, if you already have a Medicare Health Plan or Medicare Advantage Plan, you can add prescription drug coverage by telephone or over the Internet, where available. Do not, however, purchase a plan that asks you for payment over the telephone or the Internet because you will be dealing with a scam. When you enroll, the plan must bill you.

For those who have one of Medicare's approved drug discount cards, be aware that your card will be phased out by May 15, 2006, the date on which the first enrollment period for Medicare Part D ends. If you want an approved drug discount card in the interim, you must get it by Dec. 31, 2005.

The confusion with Medicare Part D appears to be centered around which plan to purchase; each plan in your state will have different prescription drug coverages, premiums and benefits. That is why it's important that you begin the selection process carefully and logically:

¢ First, list all of the prescription medications you are taking and the cost of each prescription.

¢ Second, obtain information on all plans available in your state, and make sure the prescriptions you take are covered.

¢ Third, if you receive prescription drugs through the Veterans Administration, TriCare or an employee plan that is going to continue your coverage, make sure to compare the current cost of your medications per prescription against Part D since you may well be better off keeping your current coverage - again, assuming your current plan is going to continue your coverage.

Mark the calendar

The key dates are Nov. 15, when enrollment begins, and May 15, when the initial enrollment period ends. If you purchase a plan after May 15, you will pay a higher premium. As we understand it, once you enroll in an approved plan, you will not be able to change that plan until the next enrollment period in 2006, so try to choose the plan best for you.

If you have family income of less than $14,355 as an individual or $19,245 as a couple, assistance in paying premiums, co-insurance and deductibles is available.

If you or a loved one resides in a nursing facility, you automatically will be enrolled in a plan, but, unlike non-nursing home residents, you will be able to change your plan if there is another that better fits your needs. If you are in a nursing facility and are dually eligible for Medicare and Medicaid, you will pay no premiums, deductibles, or co-insurance for your Part D coverage.

- Jan Warner is a member of the National Academy of Elder Law Attorneys and has been practicing law for more than 30 years. Jan Collins is editor of the Business and Economic Review published by the University of South Carolina and a special correspondent for The Economist.


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