 By LEE BOWMAN Scripps Howard News Service October 07, 2005
On television and in videos, senior celebrities are star hucksters for various plans. A national plan sponsor based in California, PacifiCare, has put the Mertzes, those two icons of early television from the "I Love Lucy" show, back on the air to promote sales. Medicare hadn't even been set up when Vivian Vance and William Frawley played the Ricardos' neighbors, but they squabble like old times over a new topic - the value of prescription-drug coverage - thanks to computer digitalization and sound-alike voice doubles. Other firms and organizations offering coverage are setting up kiosks inside, or in the parking lots of, drugstore chains, stuffing fliers in newspapers and mailboxes and using telemarketers to promote their plans. Between 11 and 20 organizations are offering prescription-drug plans in each region - a state or part of a state - and, in many areas, drug coverage is also offered as part of membership in Medicare-approved HMOs. That can mean as many as 70 options to consider in some states. There's at least one such plan available in every state except Alaska and Vermont. Monthly premiums are ranging from as low as $2 a month to as high as $70 for the freestanding drug benefit. The drug coverage may cost nothing, or be more comprehensive, through some managed-care (Medicare Advantage) plans. But no matter what the up-front costs, Medicare patients need to know that not all drugs they take will necessarily be covered, and most people will face out-of-pocket costs that will vary depending on how much they spend on drugs each year. Many critics of the program say the array of choices and rules may prove so daunting to many seniors that they'll make poor choices or simply skip signing up for coverage altogether. "In my humble opinion, it's the single most convoluted benefit program in American history," said Robert Hayes, president of the nonprofit Medicare Rights Center, which has been helping educate seniors and disabled people about the program. Medicare officials themselves had to admit to a goof in the new "Medicare and You" handbook. It mistakenly lists all plans as available for those who qualify as low-income with no monthly premium; in fact, only about 40 percent of the plans are available on a zero-premium basis. One survey by a New Jersey consulting firm, Market Strategies, found that only 20 percent of Medicare beneficiaries said they'd sign up for the new benefit, but another 25 percent replied they "hadn't heard enough information yet to decide." Advocates for the elderly insist the coverage is worthwhile for most people on Medicare who don't already have good drug benefits through a current or former employer. "We really believe this coverage is going to save lives," said John Rother, policy director for AARP, which is marketing its own plan and is also promoting the coverage. "There's no need to rush in, but most people will probably be better off getting the coverage than not joining up. Still, it's important to keep in mind that there is no 'typical Medicare beneficiary' when it comes to drug coverage," Rother said. Virtually everyone involved in the program, officially known as Medicare Part D, stresses that seniors and disabled people should do their homework and talk over choices with someone they trust during the next few months. An online tool for making comparisons between plans in your area will be available from Medicare next week. No one can enroll for coverage before Nov. 15, and the deadline for signing up without penalty for people presently enrolled in Medicare is May 15. Here are questions and answers that may make maneuvering through the system a little easier. Q: Are there any restrictions on sales tactics? A: Companies and organizations sponsoring plans can call you, but aren't supposed to sign up people during sales calls. You can ask for written material, and you can call a plan back to enroll over the phone if you choose. No one is supposed to sell coverage door-to-door. Be wary of any such salesperson; don't give them personal information or money. Never give out a Medicare ID number, credit-card number or other personal or financial information over the phone or Internet without being sure whom you're dealing with. You can call Medicare at 1-800-633-4227 to confirm if a company is legit. Q: What do I need to do to prepare to shop for a drug plan? A: Make a list of the drugs you're taking now and what you're paying for them. Find out what plans your pharmacy will be part of and consider whether you're willing to switch or use a mail-order pharmacy. If you have supplemental insurance coverage for expenses Medicare doesn't pay that includes drugs, you can keep it, but you can't add the Medicare benefit, too. No new enrollments in Medigap drug plans will be allowed after Jan. 1, and your Medigap insurer must let you know by mid-November how your coverage compares with the Medicare plan. If you keep Medigap coverage beyond next May, you'll probably pay a penalty if you move to Medicare D coverage later. Q: What should the plan cover? A: Each plan has to cover at least one type of drug in almost all therapeutic categories. Many will offer a larger menu. But the plan can drop coverage of specific drugs during the year with 60 days' notice. Financially, the plan has to have an overall value that's at least as good as the Medicare basic plan. Under the basic plan, with no subsidies, you would have to meet a $250 deductible, then pay 25 percent of the cost of the next $251 to $2,250 of prescriptions. You would pay 100 percent of the cost for the next $2,251 to $5,100 in prescriptions (the so-called doughnut hole in the coverage), then you'd be responsible for 5 percent of all drug expenses above $5,100 - the catastrophic-coverage threshold. Q: Are there plans that will help fill in the coverage gap? A: Medicare says that there will be at least one plan in every state that adds coverage through the gap, and with a deductible below the $250, but these may have higher monthly premiums, too. Forty-one states will have Medicare Advantage plans with at least some coverage through the gap. Q: What if I already have drug coverage through a current or former employer? A: The company should tell you if your present coverage will change. If it continues to cover you as well or better than Part D, Medicare will pay it a credit each year, or it may ask to enroll in a new Medicare plan for its retirees. It may also offer supplemental coverage to a Medicare plan, or may choose to stop providing retiree coverage. If the company does this after next year, you can still sign up for the Medicare coverage with no penalty, as long as the coverage you lost was equivalent to the Medicare basic plan. Q: Am I eligible for extra help if I'm low-income? A: Yes. Premiums, deductibles and co-pays are all subsidized if your annual income is below 150 percent of the poverty level ($14,355 a year for individuals and $19,245 a year for couples in 2005) and if you have assets of less than $11,500 for individuals and $23,000 for a couple. For some people whose income is between 135 percent and 150 percent of the poverty level, the subsidies will be on a sliding scale. Co-pays will generally be $5 per prescription or less. The Social Security Administration has mailed applications for this assistance to beneficiaries who may be eligible. But you may be eligible even if you didn't get one of the forms. Q: What if I have drug coverage through Medicaid or VA or TriCare? A: Vets and military retirees can keep the coverage they have now and enroll in a Medicare plan later with no penalty. Medicare-eligible people enrolled in Medicaid will be automatically eligible to move to select plans in the new program and qualify for the low-income subsidies. Q: I'm pretty healthy right now and take only one prescription regularly. Do I have to enroll now? A: Medicare Part D is a voluntary insurance program. No one is being forced to sign up. If you sign up later than May 15, 2006, and haven't had equivalent coverage from another government or private program, you'll pay a higher premium. The penalty is 1 percent of the national average premium for each month you delay.
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