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What you need to know about Medicare's new drug plan

August 14, 2005|By Bob Maginnis

On July 12, The Herald-Mail printed my interview with Katrina Eversole, a health insurance advocate with the Senior Health Insurance Assistance Program, on the Medicare Part D prescription program.

In that column, readers were told that Eversole had created a fact sheet and that readers who didn't have Internet access could write to me for a copy.

So many people have written that I decided that rather than send out so many separate sheets, I would try, with her help, to put all of this information in one article, which seniors and their relatives could save.

In an attempt to make it more readable, I'm using a question-and-answer format.

What is the Medicare Part D program?

Eversole: "It's a federal law which creates a prescription drug benefit through Medicare - the Medicare Modernization Act passed in 2003."

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Who is eligible?

Eversole: "Everyone who is on Medicare now and who later becomes eligible. That includes the disabled population, so it's not only for those who are over 65."

Must everyone sign up?

Eversole: "It is a voluntary program, but whether you should sign up or not is something you'll have to determine in the next few months."

How will I know whether I should sign up?

Eversole: "If you have a prescription drug plan through your former employer, they will send you a letter telling you whether it's as good or better than the federal program.

If it's as good as or better than Part D, that's the only legitimate reason that you need not enroll in Part D at that time. There will be no penalty for you if your employer decides to drop your coverage in the future and you need to sign up for Part D at a later date.

"All Maryland benefits, including Maryland Pharmacy Assistance Program, Maryland Pharmacy Discount Program and Carefirst end Dec. 31 of this year, so you will need other coverage.

"You also need to know the retail cost of the drugs you take now, so you can decide which plan will best meet your needs."

Are there any other things I should know about signing up?

Eversole: "If you are on a state-assistance program, you will automatically be enrolled for extra help with the premiums.

"Those who have been sent applications for extra assistance with premiums from Social Security should sign up for financial help. However, if you do not qualify for extra financial assistance, this does not mean that you're not eligible for a Medicare prescription drug plan. All Medicare beneficiaries can join Part D.

"Social Security staff will be available on Friday, Sept. 19, at the Washington County Health Department on Pennsylvania Avenue from 8:30 a.m. until 2:30 p.m. Though the meeting will be held on the second floor, there is an elevator and plenty of parking."

Are there any other important dates coming up?

Eversole: "Carefirst members only (those who are currently on the Carefirst Senior Rx program with a $1,100 benefit) should be aware that there will be a seminar held at the W.D. Byron Post of the Veterans of Foreign Wars at 70 E. Washington St., in downtown Hagerstown.

"It will be held on Friday, Sept. 9, from 9 a.m. until 3 p.m. (Watch The Herald-Mail papers for more details).

"There will be help available that day to help you transition into a prescription drug plan, or PDP."

How much will the new plan cost?

"The standard cost is $32.20 a month, with a $250 deductible. Other prescription drug plans will be offered that will not adhere to those costs.

"Some might say they will waive the first few months' premiums. Some might say there is no deductible. Some might say there is a higher premium, but there will be a larger list of available drugs."

Can I get assistance with the premiums? If so, how much can I get?

Eversole: You can get an application for assistance from Social Security. The amount will vary, based on your income and assets.

What are the guidelines?

"Those who qualify include individuals with less than $14,355 in gross annual income who have under $11,500 worth of assets. Your home and car don't count as assets.

"Couples qualify if they have a gross annual income of less than $19,245 and under $23,000 worth of assets. Again, your car and home don't count in the asset total.

When will we get information on the new private drug plans?

Eversole: "We were expecting some of the plans to be announced in September. Now we hear it may be as late as Oct. 13. The plans are being approved by the Medicare authorities now."

If I get into a plan and then decide it's not the one for me, what can I do?

Eversole: "You'll be locked into the drug plan for a year. If you develop other medical problems after enrolling in a plan that only covers your current drugs, there will be a special-exception process that will allow you to add new drugs to your existing plan."

People are being asked to choose a plan by Dec. 31, but open enrollment is being extended into 2006. Why is that?

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