In 2005 millions of Americans on Medicare had the opportunity to enroll in the government’s new prescription drug plan. Medicare Part D offered a host of new plans that would deliver prescription drug coverage. It required seniors to choose and enroll in a plan for the coming year. Vermont had 44 different plans to choose from during the enrollment period in the fall of 2005, and over 50 in 2006. The Council on Aging was instrumental in helping seniors navigate the confusing process of choosing a plan.
Two years down the road, Vermont will have more than 51 plans to choose from in 2007, each with differing costs and allowable coverage for drugs. As in 2005 and 2006, each plan has its own list of approved drugs (formularies) and wide variation in costs. Seniors already enrolled in Medicare Part D understand that under the sweeping government plan, prescriptions are not free. Monthly premiums, a yearly deductible, and a gap in coverage called the “donut hole” mean that seniors can spend approximately $4,000 of their own money annually to eventually cover 95% of drug costs.
Many who needed financial help in 2005 and 2006 will continue to require it. The color of the letter that each senior receives this fall will determine if they are eligible for extra help, will lose that help, or will have a change in their current plan or copayments.
In 2006 Myra qualified for extra help and did not have to send financial information to the SSA. This year is different, and she may have to fill out an “Income and Resources Summary” sheet. Myra’s caseworker at the Council on Aging stressed the following:
- Look for the return address of the Social Security Administration (SSA) on incoming mail during October
- Open the letter from the SSA right away instead of putting it off for a few days
- Fill out the enclosed application form and send it to the SSA within 30 days, or extra help may be terminated
- If help is needed, contact the Council on Aging or the State Health Insurance Assistance Program (SHIP) office for free assistance
Marlene Eddy, the Health Insurance Benefits Coordinator for SHIP in southeastern Vermont, has helped countless seniors through the process of choosing, maintaining and changing plans. “It’s important to look at your plan to see if you’re in the best possible shape for the coming year,” she says. Eddy offers the example of a couple who had high medical expenses and automatically qualified for the drug benefit in 2007. This year they may get a gray letter in the mail telling them their eligibility status has changed, along with an application for extra help.
“There are still bumps in the road,” says Eddy, who is well versed in the intricacies of Medicare Part D. For those who fall through the cracks, SHIP does interventions in this sometimes confusing process. Eddy’s advice to seniors this October is to watch for mail from the Social Security Administration, open it right away, note the color of the letter inside, fill out the required forms, and don’t hesitate to call for help if you need it.
RESOURCES
Senior HelpLine of the Council on Aging for Southeastern Vermont
1-800-642-5119
State Health Insurance Assistance Program (SHIP). Call Marlene Eddy at 1-802-885-6636
www.medicare.gov or 1-800-MEDICARE
