Medicare Part D, 2008 edition

October 20, 2008

Medicare Part D was passed by the U.S. Congress to subsidize the cost of prescription drugs for senior citizens. It was a good idea, but the implementation was more complicated than many imagined.

It was only because of Katrina Eversole, the senior health insurance advocate of the Washington County Commission on Aging, that many local residents were able to navigate the program.

But it is not a program that you sign up for once. Every year you have the opportunity to enroll in a new plan.

How do you choose? The Commission on Aging and its volunteers help you, in a series of free sign-up sessions. The schedule will be printed elsewhere on this page.


Things you should know:

1. If you did not sign up for a prescription drug plan through Medicare Part D during initial enrollment, you may be subject to a 1 percent per month penalty (cumulative), which will be imposed on top of the drug plan's premium. So, if you failed to make a choice and you didn't have other creditable drug coverage, the penalty may apply.

2. Those individuals who are becoming eligible for Medicare during the year by virtue of the fact that they are turning 65 years of age, or who will receive Medicare because of a disability, will have their own "special enrollment period." There is no need to choose a plan during annual enrollment if you are not Medicare eligible at that time.

3. At any time during the year, a person who qualifies for "extra help" (financial aid for premium and co-pays of the Rx plan) through the Social Security Administration can sign up for a Medicare Part D plan (with a proof of "subsidy" letter). If you have not applied for extra help, go to the Social Security Administration office on Maryland Avenue as soon as possible.

4. Individuals who are carrying employer group health coverage that is "creditable" are exempt from signing up for a Medicare Part D plan during annual enrollment period. They should have a letter stating that their coverage is "as good as or better than Medicare Part D."

If your employer decides to terminate your Rx coverage, you will have a guaranteed period of time to choose a Medicare Part D plan, regardless of whether or not it is during annual enrollment period.

Bring your Medicare card, your current prescription Rx card and a list of your prescriptions (with exact dosages and strengths). You will be counseled and shown your available options.

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

Questions on Part D for this year

1. What, if anything, is different this year?

There will be 48 stand-alone prescription drug plans in Maryland for 2009 (there were 52 Rx plans in '08)

a. There are 16 drug plans that have a $295 deductible, five plans that have annual deductibles under that amount and 27 plans with no deductible at all

b. The coverage gap or "doughnut hole" has been set at $2,700 in 2009. This amount is determined by the amount that you pay in co-pays for each of your drugs AND the amount that the drug plan has contracted with the pharmaceutical companies for the cost of your particular drug -- when a person reaches the doughnut hole (and many will not, because they use generics or their costs are low), then the person is responsible for the full cost of their drugs and must continue making premium payments each month to that plan

c. If you come out on the "other side" of the doughnut -- which has been set at $4,350 for 2009 -- then Medicare will pay 95 percent until the end of the year.

2. Are there new products out there?

Even though Medicare Advantage Plans and Private Fee for Service Plans are not new products, they are fairly new to Washington County. Educate yourself and be informed before signing on the dotted line when joining an MA or PFFS plan. When joining one of these "managed care" plans remember that the monthly premium for Medicare Part B ($96.40 in 2009) will stop going to Medicare and will go directly to the plan as premium or partial premium. This means that Medicare will not be your primary coverage and will not be able to process claims. Here are some things that you should know about MA or PFFS plans:

a. Not all doctors and hospitals are willing to treat members.

b. There is no limit on the amount a PFFS plan can charge for monthly premiums.

c PFFS plans may mean higher out-of-pocket costs than original Medicare. There may be "hidden costs"

d You cannot purchase supplemental insurance (or Medigap) to fill these gaps.

e. PFFS plans can increase your premium or stop offering Medicare benefits from one year to the next.

f. The plan is run by a private company and it decides the rules for covering your benefits and payments. It doesn't follow Medicare's rate schedule

g. Each year these plans can change benefits, premiums and other costs to you ... or even decide whether or not to offer the plan.

h. Each year, during Open Enrollment -- Nov. 15 through Dec. 31 -- you can decide whether to stay in your plan, switch to another, or return to traditional Medicare.

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