Medicare Prescription Drug Plans Rolling Out This Week

Beginning this week, Medicare beneficiaries should expect to receive mailings, emails and calls from telemarketers representing private insurers and health care companies, marketing their Medicare Part D prescription drug plans. In California, Medicare enrollees will choose from 47 stand-alone Medicare Prescription Drug Plans, including the 10 approved national plans, and another 113 Medicare Advantage Plans, InsideBayArea.com reports. In other states, USAToday reports, more than 20 companies will be offering competing plans.

“People are very confused,” Vicki Gottlich of the Center for Medicare Advocacy told USAToday. “Part of the confusion stems from all the variables. If you are going to get mailings from 15 different companies offering a different array of plans, you might throw it all in the garbage.”

The plans target a “wide range of medical needs and financial means”, according to the Wall Street Journal, and companies will also likely target their marketing efforts. Some plans are designed for people who don’t take much medicine, while others, with much more expensive monthly premiums, will target people who have high drug bills and cannot take generic medicines, the Journal reports.

Enrollment in the Medicare prescription drug program begins November 15th, and benefits begin January 1, 2006. Open enrollment will continue to May 15. After that time, Medicare beneficiaries who do not currently have prescription drug coverage through employer-provided plans will pay a penalty for enrollment.

A typical plan may cost from $20 to $37 a month, USAToday reports. Participants will pay a deductible, $250 in many cases, and may pay co-pays, depending on the plan and the medicines they use, the Journal reports. Medicare will pay 75 percent of the cost of prescriptions up to $2,250, when enrollees reach the “doughnut hole”. Seniors will then pay 100% of their drug costs up to $5,100 annually, when Medicare covers 95 percent.

Some plans offer coverage of the “doughnut hole”, the Journal reports, but these plans have higher monthly premiums.

In reviewing their myriad options, seniors should consider their monthly drug costs, convenience and/or mail order options, whether the plan offers “doughnut hole” coverage, and finally, the drug formulary, the list of drugs each plan will pay for, InsideBayArea says. Medicare beneficiaries who are already enrolled in Medicare Advantage plans in California should check to see if they will lose benefits by going with another company’s prescription drug plan. Kaiser Permanente has already warned members that they risk losing their coverage if they select another provider.

Dr. Mark McClellan, of California’s Centers for Medicare and Medicaid Services says that the plan choices are good news for people with Medicare, especially when they are struggling to pay their drug bills, InsideBayArea reported. “No Medicare beneficiary has to make a decision now, McClellan said. “This is the time to start thinking about Medicare prescription drug coverage.”

Seniors should not give any personal information to telemarketers or by email during the marketing campaigns. Callers who ask for social security numbers, for example, could be setting up a potential scam, RedNova.com reports.

States and the federal government will be setting up numbers to assist Medicare recipients in making their choices. In addition, www.Medicare.gov, Medicare’s Web site, will offer several features, including the opportunity for beneficiaries to compare costs for drugs under various plans, the Wall Street Journal reports. Another government site, www.cms.hhs.gov provides a breakdown of plans by state.

Seniors have been resisting the Medicare prescription drug program, saying they don’t understand it, despite education programs sponsored by the government and groups like AARP, USAToday reports. The newspaper released the results of a poll taken in September that showed only one in four seniors say they plan to join the program.


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