Frank watches over his mother Ina, 79, who lives close by. Ina has enjoyed good health all her life and taken no medications. But this year, when her blood pressure spiked, her physician ran tests to assess her overall health. Ina had developed hypertension and her cholesterol levels were high, prompting him to put her on two medications.

"Because my mother never took pills we didn't pay much attention to the whole Medicare Part D prescription drug plan when it was in the news a year ago," says Frank. "I was glad I didn't have to do the research and choose among all the confusing plans out there."

In the fall of 2005 millions of Americans on Medicare, regardless of income, health status or prescription drug use, had the opportunity to enroll in the new plan put in place by the government. It made sweeping changes in how they would receive and pay for their drugs. Every state offered a menu of plans, many of them confusing to consumers with their differing costs and allowable coverage for drugs. Each plan had its own list of approved drugs (formularies) and wide variation in fees. In Vermont there were 44 plans to choose from, and next year there will be 51.

The prescriptions are not free. Not until you pay over $4,000 out of pocket will the plan kick in 95% of the costs. Until then, your costs in 2007 under Medicare Part D can look like this:

• about $35 monthly premium
• $265 yearly deductible
• co-insurance after the deductible is met will be 25% of
  drug cost, up to $2400
• you pay 100% of the next $3052 gap in coverage (the "donut hole"). Many need financial help with this part.

The process of picking the right plan was confusing last year and will require many of this year's new enrollees to seek help in sifting through the information. Last year the Council on Aging came to the rescue of many seniors by offering links to free assistance from advocates, case managers, and the State Health Insurance Assistance Program (SHIP). SHIP can help clarify what benefits are covered under Medicare, answer questions about medical bills and insurance summaries, and offer counsel on how to choose a Medigap policy or long term care insurance. Their office also assists elders in investigating fraud, error or abuse related to health care.

The next opportunity to enroll without a late penalty is November 15 - December 31. The Council on Aging urges seniors who need to enroll or make changes to existing coverage to call the Senior Help-Line (see Resources). Applications for prescription drug plans can be filed as early as October. Before you choose a plan make a list of all medications you take. If a plan you are interested in doesn't cover all your drugs, ask you doctor if you can change prescriptions. If there is no substitute, your doctor can request that your chosen plan cover it.

Fortunately for Ina, Frank does a lot of online research. He will be able to go to websites like AARP, Medicare and Social Security to research the different plans in advance. Other options for internet help are friends, neighbors, young family members, and the local library.

The important dates to remember for enrollment are November 15 through December 31. The Council on Aging encourages people to call their office to explore what the options are.

RESOURCES

• Senior Help-Line (800-642-5119)
• State Health Insurance Assistance Program (SHIP). Call Marlene Eddy at 885-6636.
• Medicare Help Line (800-MEDICARE), or www.medicare.gov
• Eldercare.gov website offers counseling advice.
• Social Security (800-772-1213, 802-775-0893, or www.ssa.gov) can tell you if you qualify for extra help paying for your plan.
  

 

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