Drug plan not unflawed, but can save cash

February 05, 2006|By CANDICE BOSELY

Asked for her overall opinion of Medicare's new prescription drug plan, called Part D, Berkeley (W.Va.) Senior Services Outreach Supervisor Beverly Gerlach hesitated.

"You don't want to ask me that. You're going to quote me on this, right?" she asked.

She considered the question, trading looks with her boss.

Finally Gerlach said that she thinks it's a good program that has the ability to save people money, but that it was put into effect before all of its flaws had been worked out.

She should know - she's been dealing with seniors who have a range of questions about the program and have encountered problems while they enrolled or after enrolling.


"Beverly spends about 100 percent of her time, plus she has three part-timers, to try to keep up" Berkeley Senior Services Executive Director Linda Holtzapple said.

Only a small amount of funding - $1,000 - was given to the center to help.

"We're expected to do this, what we're affectionately calling an unfunded mandate," Holtzapple said.

Some say the easiest way to enroll is by going online, but seniors often do not have a computer or do not know how to get on the Internet. Holtzapple wants to recruit volunteers to help seniors enroll online.

In Washington County, every Friday morning from 9 a.m. to noon seniors can go to Hagerstown Community College and sit down with a student who will help them enroll online. Such sessions will be held through the end of April, except for Feb. 17 and March 17.

Katrina Eversole, a health insurance advocate with the Senior Health Insurance Assistance Program who works out of the Washington County Commission on Aging's office in Hagerstown, will be there to answer questions about Part D.

A Commission on Aging representative also will be at Washington County Free Library in Hagerstown on Tuesday afternoons, from 1 to 4 p.m. to help seniors get on the Internet to enroll in a plan.

"We're trudging through and getting people where they need to be," Eversole said.

The ABCs of Part D

Part D, intended to save people money on their prescription drugs, allows people to choose from among dozens of competing private insurance plans.

The program took effect on Jan. 1. Anyone eligible for Medicare, regardless of income, is able to enroll in Part D.

About 42 million older and disabled U.S. residents are eligible to enroll. The government subsidizes the drug coverage, with additional subsidies provided for those with low incomes.

Enrollment ends May 15 for this first-time startup period, with one plan change allowed before then. Afterward, participants will need to sign up on an annual basis, with future enrollment periods set to run from Nov. 15 through Dec. 31 of each year.

Enrolling is optional. Those who have a plan already - for example, a plan offered by an employer - may keep that plan if its benefits are as good or better than Part D.

Enrolling in Part D does not affect medical coverage from Medicare.

All plans must offer brand-name and generic drugs and must include at least two drugs in a therapeutic or diseases class. If a pharmacy decides to withdraw a drug that has been on its list, it must notify the beneficiaries in writing.

Those who are eligible to enroll but choose not to participate will be penalized if they attempt to enroll after the sign-up period ends. Such people might want to sign up for the cheapest plan now and adjust it later if needed, Eversole said.

Those with a "creditable" plan outside of Part D now can enroll later and not have to pay the penalty, provided they can prove their plans were as good or better than Part D.

Creditable plans include those offered by Veterans Affairs; TRICARE, a plan for members of the military; and the Federal Employees Health Benefits Plan.

In Maryland there are 47 Part D plans from which to choose, with deductibles of up to $250.

The average monthly premium is $32.

After reaching their deductible, seniors pay 25 percent of their drug costs and Medicare pays the other 75 percent. Low-income seniors might qualify for additional help to ensure they pay no deductible and that prescriptions cost no more than $5 each, Eversole said.

Drugs that are not paid for in the plan include those used to treat anorexia, weight loss or gain, fertility-related problems, symptomatic relief of a cough or cold, or for cosmetic or hair-growth purposes. It also will not pay for prescription vitamins and minerals, barbiturates, over-the-counter medications and benzodiazepines, Eversole said.

She said several state programs that provided drug coverage to those on Medicare were discontinued at the end of 2005, including the Maryland Pharmacy Assistance Program, Maryland Pharmacy Discount Program and the CareFirst Senior Prescription Drug Program.

Medicare-approved discount drug cards will be phased out by May 15.

Enrollment problems

Many seniors have experienced problems while trying to enroll or after enrolling in Part D.

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