Medicare drug change will affect 20,000 in county

June 02, 2005|by BOB MAGINNIS

By and large, when it comes to their routines, senior citizens prefer the familiar to the unexpected. It's a better day for them when the newspaper and the mail arrive on time and when the teller at the bank is someone they know by name.

That's why what will happen in the next six months to a year will be doubly difficult for seniors and the people who love them.

If you're one of the latter, paying attention now may help your parent or relative through what could be a bureaucratic ordeal.

Some background: In December 2003, President Bush signed the Medicare Modernization Act. It created what is called Medicare Part D, which is a prescription drug benefit.


Part D will replace a variety of plans, both private and public. And, as is often the case, it won't be easy to get the system from where it is now to where it's going.

So says Katrina Eversole, a health insurance advocate with the Senior Health Insurance Assistance Program, which is headquartered in the offices of the Washington County Commission on Aging in downtown Hagerstown.

"This is going to be the biggest challenge since Medicare started," Eversole said, adding that no fewer than 20,765 Washington County residents will be affected.

Paying attention now is key, she said, "because I can't counsel 20,000 Medicare beneficiaries one-on-one," she said. She added that because so many details of what will happen have not been worked out, calling her now will yield little more information than what appears in this column. Later, when more details are available, public-education sessions will be held, she said.

The important thing now, she said, is to pay close attention to what you get in the mail. A variety of key documents will soon start arriving, if they haven't shown up already, she said.

· The first mailing

This month, Eversole said, the Social Security Administration (SSA) will begin mailing Medicare beneficiaries, telling them that depending on their income, they may be eligible for extra help in paying their Part D premium. Without help, it will cost $35 to $40 per month.

That notice will include an application, she said, which should be filled out and submitted through the mail, or completed after July 1 at the offices of the local Department of Social Services.

(Sessions offering help with that application have been scheduled and a date and times appear at the end of this column.)

· Determining eligibility

After July 1, SSA and state Medicaid agencies will review applications to determine whether seniors' income is low enough to qualify for help with the Part D premium,.

"It's a review and you won't know the outcome until after July," she said.

· Private and union plans

Also this year, private employers and unions that offer prescription-drug benefits must notify those they cover whether their plans are as good or better than Medicare Part D.

If they're not as good, Eversole said, the beneficiary will have to decide whether to sign up for Part D, or do without it. If the plan is as good or better, Eversole said, the beneficiary can elect to stay with it.

Pay attention to any mail you receive on that topic, she said.

Throughout this time, there will also be mailings from Medigap insurers and Centers for Medicare and Medicaid Services.

· Open enrollment·

Beginning Nov. 15, Eversole said that beneficiaries will be able to sign up for a drug plan. There will be a minimum of two drug plans per region, operated by private suppliers.

Information on specific plans will be available starting in September, when providers begin their marketing efforts, she said. Seniors have until May 15, 2006, to choose a plan, but may want to do so by Dec. 31, in case other benefits expire at that time, she said.

· Part D takes effect

On Jan. 1, 2006, the new Part D system begins operations. And those who haven't made a choice may have a scary moment if they go to a pharmacy after the start of 2006 and present a Maryland Pharmacy Assistance card.

That's because Maryland's Pharmacy Assistance Plan is going to end in December, she said.

· For more information

On Monday, June 13, the SSA will hold four sessions to help low-income seniors fill out applications for help with Part D premiums.

The sessions will be held at the Washington County Health Department on Pennsylvania Avenue at 8:30 and 10 a.m. and 1 and 2:30 p.m.

To qualify for help, individuals must have a gross annual income of less than $14,355 and assets of less than $11,500. Couples must have a gross annual income of less than $19,245 and assets of less than $23,000. One's home and car do not count in the asset total.

My advice: Keep an eye on the mailbox and this newspaper for updates on public-education sessions.

Bob Maginnis is editorial page editor of The Herald-Mail newspapers.

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