In order to receive coverage for prescriptions under
the new Medicare Part D, seniors must choose and enroll
in one of the many drug plans offered by the government.
There will be a variety of choices and a schedule for
enrollment (November 15, 2005 through May 15, 2006, with
a penalty fee after May 15).
The plans will be sold to consumers by private companies
instead of the government, and coverages may vary widely.
In Vermont 17 companies will offer 44 plans, possibly
more. Each will have its own list of covered drugs (formularies),
and it is crucial to choose the plan that covers the drugs
and specific brand names that you require.
The prescriptions are not free. Not until you pay $3600
out of pocket will the plan kick in 95% of the costs.
Until then, your costs under Medicare Part D can look
like this:
- about $35 monthly premium
- $250 yearly deductible
- co-insurance after the deductible is met will be 25%
of drug cost, up to $2250
- you pay 100% of the next $2850 (this is the gap, or
"donut hole," in coverage that many will need
financial help with)
AARP Magazine published an article in their November
issue that poses eight points for seniors to consider
when choosing a plan. Among them are:
* You are eligible for Medicare Part D if you currently
receive Medicare, no matter what your income is.
* If Medicaid now pays for your prescriptions, after December
31, 2005 your drugs will not be covered. Instead, you
must enroll in a Part D plan.
* If you are single with an annual income of $14,355 or
married with $19,245 or less, you may qualify for help
paying for some Medicare Part D costs. You must apply
for this low income assistance with the Social Security
Administration.
By the end of October the government should have sent
seniors a guide called Medicare and You, which describes
the plans available in Vermont. The initial enrollment
period begins November 15. Before you choose your plan:
- make a list of all medications you take
- make sure the pharmacies that participate in the plan
are conveniently located for you, or if you can have
prescriptions mailed
- if your plan doesn't cover all your drugs, ask your
doctor if you can change prescriptions. If there is
no substitute your doctor can request that your chosen
plan cover it.
If you are a senior who has crossed the digital divide,
your own computer or a public one in your local library
can lead you to online analysis and comparisons of available
plans. Go to: www.medicare.gov
and click on "Plan Finder." If you aren't Internet
savvy, ask for help from a friend, neighbor or family
member who is. The online information is just a few clicks
away.
The changes are coming soon and it is important that
you learn as much as possible by November 15. Senior advocates
are getting the word out, so watch for announcements in
your local papers for informational meetings that can
help you understand Medicare Part D.
As an advocate recently stated in Newsweek magazine,
"Keep it simple. Pick the cheapest plan that offers
the drugs you use, dispensed at a pharmacy that's easy
to reach."
RESOURCES AND IMPORTANT DATES
November 15, 2005: first day you can enroll.
January 1, 2006: first day you can use your chosen
plan if you enrolled before December 31, 2005. Otherwise,
you begin your plan on the first day of the next month
after you sign up.
May 15, 2006: last day to sign up without a penalty.
- Senior Help-Line (800-642-5119)
- Social Security (800-772-1213 or 802-775-0893 or
www.ssa.gov) can
tell you if you qualify for extra help.
- State Health Insurance Assistance Program (SHIP).
Call Marlene Eddy for information about assistance
(802-885-6636).
- Medicare Help Line (800-MEDICARE).
- www.eldercare.gov
offers counseling advice.
