Are you and your parents ready for new Medicare drug plan?

July 12, 2005|by BOB MAGINNIS

If you have a mother, father, grandparent or other relative who is covered Medicare, talk to them right now, this week.

If you don't, your loved ones could find themselves at the drug store with a prescription card that's no longer valid, or paying a penalty on their premium for not completing paperwork on time.

And it's not just a few people who will be affected. Almost 20,000 Washington County senior citizens could be covered under the Medicare Modernization Act, a prescription drug benefit program also known as Medicare Part D.

According to one local expert, a lot of seniors aren't doing what they need to do to get ready for the changes that will come this fall.


Katrina Eversole is 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.

She's held several public-information sessions on the program, which began sending out applications for assistance with the Part D premiums, which will cost $37 per month.

She said some seniors who attended have told her that they received the applications, but threw them out. Other have come up afterward and said:

"This doesn't apply to me because I have this Maryland Pharmacy Assistance Card, right?"

Wrong, Eversole said. Though it was covered in her program, she tells them again that the Maryland program ends on Dec. 31 of this year.

Though the private companies that will provide the Part D prescription plans won't start advertising their plans until September, Eversole is pleading with local citizens to become informed now, for two reasons.

"In the fall it's all going break loose and people will be scrambling," she said.

And, she said, she has figured that if she spent 20 minutes counseling just 15,000 of the seniors who will be affected, it would take her a year and nine months. She simply doesn't have the time to do this job on a one-on-one basis, she said.

The means seniors and their relatives will have to do much of this on their own.

Last month, the Social Security Administration (SSA) sent out applications for assistance with the $37-a-month Part D premium. This month, SSA will determine who's eligible for that help.

During this time, seniors should also be receiving letters from the insurance companies telling them whether the coverage that they have is better than the Part D plan.

"The Board of Education has already sent out its notice that its plan is better, so their retirees do not have to sign up for Medicare Part D," she said.

Those are the kinds of letters that seniors and their relatives should be looking for, Eversole said, adding that the so-called Medigap providers will also be sending similar letters.

Making that decision is important, Eversole said.

That's because al though it may make sense to do without it now if your prescription drug costs are low, it may be a boon later if you develop diabetes, cancer or another condition that requires a great deal of medication.

SSA is still sending out forms for assistance with Part D premiums, Eversole said, adding that said she said SSA officials are telling recipients, "If in doubt, fill it out."

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.

So what do you get in Part D? Eversole said that the average plan will be $37 per month, with a $250 deductible. After that, Medicare pays 75 percent and you pay 25 percent, until your out-of-pocket expenses reach $2,250.

"After that, Medicare stops paying until you reach $5,100 out of pocket - this is known as the 'donut hole,'" she said.

At that level, seh said, you have "catastophic costs" and Meedicare picks up 95v percent.

In fall, the drug companies will begin advertising. By Nov. 15, Part D recipients must choose a plan. Eversole said there will be public-information sessions then, but they haven't been scheduled yet because drug companies haven't released information on their plans yet.

In the meantime, Eversole's advice is to read all your mail - or that of the seniors in your family. Ask your pharmacist for a retail listing of the drugs you take and find a family member, friend, caregiver or neighbor to attend any upcoming meetings with you.

For help with filling out SSA Part D forms, you may go the the Washington County Health Department on Friday, July 22 and Friday, Aug. 19, from 8:30 a.m. to 2 p.m. in second-floor conference room.

Eversole prepared an information sheet that will be posted on The Herald-Mail Web site along with this column. If you cannot access the Internet, you can receive a copy of it by writing to Editorial Page Editor, The Herald-Mail, 100 Summit Ave., Hagerstown, Md., 21740.

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