Oct. 14, 2006
HEALTH: Time to Reconsider Your Medicare Drug Plan
By Lee Bowman
Scripps Howard News Service
Washington, DC (SHNS) -- Beginning a month from now, seniors will have a
chance through the end of the year to change their Medicare drug coverage,
or start it if they didn't sign up the first time around.
Although the marketing has been under way for weeks, most of the roughly 30
million beneficiaries who are already enrolled in Medicare Part D plans and
are content with their coverage, don't have to worry about changing.
"If you are satisfied with your plan and want to stay with it, you don't
need to take any further action,"' said Dr. Mark McClellan, administrator of
the Centers for Medicare and Medicaid Services.
The government estimates that 83 percent of beneficiaries around the country
have access to drug plans with lower premiums in 2007.
After getting a few months experience in providing the coverage this year,
many plans are improving their coverage. The average number of drugs covered
is expected to rise by about 13 percent, McClellan said in interviews with
health reporters Friday. And people in most states will have 50 to 60 plans
to choose from, including 17 plans being sold in all 50 states, up from nine
this year.
In a figure tinged with controversy, Medicare says the average monthly
premium for drug coverage will be $26 next year, up from $24 this year.
Democratic critics in Congress say that calculation includes premiums paid
to Medicare managed care plans that also provide drug coverage, which cover
about 10 percent of enrollees. If freestanding drug coverage alone is
counted, the average monthly cost rises to $29.
Still, most seniors have indicated in various surveys that they're generally
pleased with their drug coverage, even with gaps in coverage and some
restrictions on which drugs people get.
That doesn't mean they won't shop around a little for a better deal, though.
For instance, Florida beneficiaries will be able to choose from 58 plans
that have premiums ranging from $10.20 a month to $83.70 a month. The plans
carry a huge array of differences in out-of-pocket costs, deductibles,
co-pays, coverage limits and range of drugs covered.
McClellan said about 300,000 low-income seniors will be forced to switch
plans to stay in a subsidized plan with low costs, mainly due to changes in
the details of certain plans rather than plans shutting down entirely. Those
beneficiaries should get notices sometime this month about the need to find
a new plan.
Everyone already enrolled in the program will get a notice of 2007 changes
from their current plan. And while the deadline is Dec. 31, 2006, people are
encouraged to sign up by early December to ensure they have a new drug plan
card in hand to pay for prescriptions come January.
Medicare's basic plan pays 75 percent of seniors' drug costs up to $2,250
after meeting a $265 deductible. Coverage then stops entirely until drug
costs reach $5,100, after which Medicare will cover 95 percent of costs.
There will be more plans that offer coverage for some or all costs incurred
during that "donut hole" period, which affected about 10 percent of
enrollees this year. Most plans will require that patients mainly use
generic drugs during this period.
As with the original enrollment period, Medicare, the drug and insurance
industries and senior advocacy groups are geared up to help the elderly and
disabled people consider their choices.
"If you want to consider other options, we have enhanced the tools that make
it easier to get the coverage that's right for you," McClellan said,
presenting an update of the Medicare Prescription Drug Plan Finder Web tool
on the Medicare.gov Web site.
It includes a monthly cost estimator that will allow users to chart how drug
spending will go each month of the year under a specific plan and new
features to compare plans based on price and benefit structure.
People without Internet access or skills can still use the computation tools
by calling the Medicare hotline 1-800-633-4117 and working with a counselor
or visiting local state health insurance assistance programs or workshops
that are again being presented by various senior activist and support groups
this fall.
Medicare is also sending out a new "Medicare and You" handbook this month,
which includes tips on selecting a plan and an overview of options.
Another tool has been produced by associations representing health plans,
drug stores and pharmacists, and will be distributed in printed form at drug
outlets and online at www.healthdecisions.org/guide.
Another group of health-affiliated organizations is concentrating on getting
the estimated 3 million low-income Medicare beneficiaries who didn't sign up
for drug coverage last time but are eligible for subsidized premiums to
enroll before a Dec. 31 deadline.
Unlike better-off beneficiaries who skipped enrolling, those eligible for
subsidies face no late enrollment penalties. "But now we all need to reach
out and make sure that people actually fill out the paperwork or apply
online for this very valuable benefit," said James Firman, president of the
National Council on Aging, one of the organizations promoting the signup.
Material about enrolling is available at www.AccessToBenefits.org;
www.maprx.info, and www.nationalhealthcouncil.org/help
Contact Lee Bowman at BowmanL@SHNS.com. Distributed by Scripps Howard News
Service, http://www.shns.com