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Medicare Part D causing concern across nation

Monday, November 28, 2005

The new Medicare Part D Prescription Drug Benefit plan has created a lot of confusion and anxiety among the elder population of this country.

Basically, the new Part D plan covers anyone who is eligible for Medicare (65 years and older or someone who has a disability) or anyone who is enrolled in Medicare Part B. Note that Part D is not only for people with a low-income; there is extra help for people who fall into that category.

It is important to realize that if you are eligible, the sign-up deadline is May 15. After retirement, if you have a comparable or better prescription plan offered through a previous employer, you will not face a penalty if and when you decide to sign up for Medicare Part D, but you must have proof that your plan was competitive.

If you do not have a comparable or better prescription plan, are eligible and do not enroll, you will face a penalty of 1 percent of the premium for each month that you fail to enroll. This penalty will be added to your premium rate once you do sign up for a Medicare Part D plan. You will pay this penalty for as long as you have a Medicare plan.

It is very important for people to think ahead, said Bette Lindley of the Area 7 Agency on Aging and Disabled. Just because someone is in good health and does not take any medications, some day they may not be so fortunate. This idea is similar to home and car insurance. It follows the "just in case" principle. To avoid the penalty, it is best to sign up for a prescription plan that has a very low premium just in case you need the prescription plan later. The plan you choose can be changed each year between Nov. 15 and Dec. 15.

Assistance can be found when making decisions about Part D by calling the Senior Health Insurance Information Program (SHIIP) at 800-452-4800, visiting the Medicare Web site www.medicare.gov and reading the "Medicare and You 2006 Handbook" which can be downloaded from the Web site or obtained by calling 800-MEDICARE (800-633-4227).

According to Grace Chandler, director for Hoosier Rx (Indiana's prescription drug assistance program for seniors), the Medicare Part D Prescription plan offers 17 insurance companies for Indiana residents to choose from. Those insurance companies have a total of 42 different plans with a different yearly deductible, gap coverage, prescription drug coverage and prescription drug tiers.

It is very important to compare the plan's tiers. A prescription drug through one plan could be on tier one or tier two while another has it on tier three. Tier one is considered generic drugs and are the cheapest to pay for out-of-pocket cost sharing. Tier two is for preferred brand-name drugs and cost more than tier one drugs. Tier three are for non-preferred drugs and are the most expensive. Some plans do not even cover tier three drugs, forcing you to pay the full price without cost sharing.

It is important to choose a plan that covers most of the prescriptions you are on and one that has your drugs on the lowest tier possible. Also, you should choose one that covers your pharmacy or one that covers prescriptions by mail.

Keep in mind that a lower premium typically means there may be a deductible and no gap coverage. Most insurance companies have a gap in their benefits. Your deductible and tiered cost sharing adds up. After a certain amount, the company makes you pay full price for prescriptions until you have reached a certain amount, if you don't have gap coverage. Then your insurance will kick in again. If you are on expensive medications, choosing a plan with gap coverage will most likely be the best choice.

Chandler suggests, "Read your materials on the Medicare Prescription Drug Plans, call companies and make a decision by mid-December for coverage January 1, when Medicare insurance companies begin providing drug coverage."

Lindley recommends calling the insurance companies directly and asking them the questions that you come up with. However, "Do not allow them to enroll you over the phone. Make them send you a application and information packet." That plan may not be the best one for you.

Once you have decided on a company and a plan, you can enroll by visiting www.medicare.gov, calling 800-MEDICARE (800-633-4227) or by calling the insurance plan's number directly. Remember, you can change your plan each year between Nov. 15 and Dec. 15 if it doesn't work out for you.

For seniors who need extra help, HoosierRx may be able to help you with Medicare Prescription Drug plans costs. HoosierRx may cover monthly premiums and provide an annual allowance to cover deductible and/or cost sharing for plans working with HoosierRx. Indiana seniors 65 or older that have a yearly income at or below $14,355 (if single) or $19,245 (if married) and have enrolled in a Medicare plan that works with HoosierRx can apply for Extra Help by completing the "Application for Help with Medicare Prescription Drug Costs" through the Social Security Administration (800-772-1213). After completing this list, call HoosierRx at 866-267-4679 to receive help with your plan costs.

Don't get stuck paying outrageous prescription drug costs on a fixed income. Know what your medications cost and how much the insurance companies are willing to pay. Be prepared, knowledgeable and don't be afraid to ask someone for help. One of the best resources you can find will be a presentation about the new Medicare Part D.

SIDEBAR:

Seminars are available for people who have questions. Bette Lindley with the Area 7 Agency on Aging and Disabled has scheduled training seminars for the public to attend. Some upcoming seminars are:

Dec. 6-- Maryvale Apartments at 3461 Saint Marys Road, West Terre Haute, from 9 - 11 a.m. Space is limited, so call 812-535-1242 for reservations.

Dec. 7-- Rockville Christian Church at 292 West U.S. Highway 36, Rockville, from 10 a.m. - noon. Space is limited, so call 765-569-6900 or 765-569-5299 for reservations.

Dec. 14-- Kidney Center of Terre Haute at 615 8th St., Terre Haute, from 9 - 10:30 a.m. Space is limited, so call 812-238-1400 ext. 225 for reservations.

Dec. 14-- Peddle Park Housing at 1616 South 25th, Terre Haute, from 1:30 - 3 p.m. Space is limited so call 812-235-8058 for reservations.

To schedule a training seminar, contact the Area 7 Agency on Aging and Disabled at 1-800-489-1561.



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