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Medicare drug plan begins next chapter

October 16, 2005|By Bob Maginnis

What's the best thing you can do in regard to the new Medicare Part D prescription drug plan?

Stay cool. Don't get angry, because it won't do you any good.

So says Katrina Eversole, a health insurance advocate with the Senior Health Insurance Assistance Program who works out of the offices of the Washington County Commission on Aging.

Eversole is the person in Washington County most likely to know how to navigate through this process. But she said she's worried because when she speaks to citizens' groups there are always people who sit there fuming and grumbling about the change and how hard it will be.

She's concerned about that, she said, because she's afraid that some people are letting their anger prevent them from learning all that they can about the program.

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If you want to blame someone, don't blame her. I suggest that you blame Congress and the president who signed it into law.

Eversole is on your side. That's why she's spent hours with me this year explaining the program - and why she is preparing information for public education seminars - so she can share her knowledge with our many readers.

She cannot counsel every recipient on a one-one-one basis, because there are thousands who are eligible in Washington County. That's why it is important to pay attention to your mail and attend one of the upcoming seminars with a friend or relative who can help by taking notes.

The seminars will be held at the Robinwood Medical Center, Suite 142. Use the blue or silver entrance. The dates are as follows:

· Monday, Nov. 7, at 9 a.m. and Friday, Nov. 18 at 1 p.m.

· Tuesday, Dec. 6 at 9 a.m., Monday, Dec. 12 at 9 a.m. and Monday, Dec. 19 at 1 p.m.

· Monday, Jan. 9, at 1 p.m., Wednesday, Jan. 18 at 9 a.m. and Tuesday, Jan. 31 at 1 p.m.

· Friday, Feb. 10 at 1 p.m.

I recommend that those who have questions attend a seminar before the end of the year, because some existing drug plans will expire on Dec. 31. Those enrolled in such plans need to work out a new arrangement before Jan. 1.

Fortunately, there will be additional help to do that. Eversole said that those who come to seminars will learn what Part D is, whether their own plans will expire Dec. 31, how the new drug plans work and whether they are eligible for financial assistance.

But there are things that you won't be able to do at the seminars. You won't be able to sign up for one of the drug plans that private companies will offer under the Part D program, because applications for drug plans will not be available at that time.

One must personally contact the company to request an application, or apply online.

To find out about plans, Eversole suggests first calling your pharmacy, to see which plans they will deal with. There are 47 plans in all and it's unrealistic to believe every pharmacy will offer all of them.

How do you find out which companies are offering drug plans?

You should get some help in the mail this month, when the Centers for Medicare and Medicaid Services send out their new handbook, "Medicare & You 2006."

The 98-page document not only tells you how to work through the process, but it also includes a list of the 47 approved plans and what the monthly premiums and co-pays will be.

Many of the plans' descriptions say that if you are eligible for extra financial help, the entire cost of the premium will be covered.

But Eversole emphasized that whether or not you qualify for assistance, you still must make a choice.

"Everywhere I go, people still think this is for low-income people," she said.

"It's not. Every Medicare beneficiary must make an informed choice," she said.

Reaching that choice means first determining if your current plan will expire at year's end. And if it will continue, will it be "creditable," which means: Will it be as good or better than the Part D program?

Medicare beneficiaries should already have received a letter from their employer's group insurance saying whether the plan they offer is as good or better as Part D and whether it will continue.

If your present plan is as good or better, you can stay with it. If not, you must choose a new plan, or face a 1 percent per month penalty that will kick in when you finally do enroll.

For example, plans that will continue and which are creditable are the Federal Employees Health Benefits Program, the Veterans Administration program and Tri-Care.

Plans that will not continue include Medigap plans with H, I and J prescription coverage, Maryland Pharmacy Assistance Program, Maryland Pharmacy Discount and the CareFirst Senior Prescription Drug Program.

CareFirst is offering people now in that program a $25-per-month subsidy for Part D premiums. CareFirst will sponsor a trade show with representatives from the various drug plans on Tuesday, Nov. 1, at Hagerstown's Clarion Conference Center.

On Friday Nov. 4, CareFirst will hold a seminar for their members at American Legion Post. No. 202 in Williamsport. Both are invitation-only events that will run from 9 a.m. to 2 p.m.

Finally, even if you don't take any prescription drugs now, Eversole said it would be prudent to join the cheapest drug plan to avoid the 1 percent penalty assessed if you don't sign up.

Eversole gave me more information than I could possible include in this column, but I will have more available in a fact sheet next week. If you'd like a copy, please write to Editorial Page Editor, The Herald-Mail, P.O. Box 439, Hagerstown, MD 21740 or e-mail me at bobm@herald-mail.com.

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