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You'll have Medicare drug choices

Floridians will have dozens of options, the details of which will be revealed once marketing begins Oct. 1. The benefit goes into effect Jan. 1.

By KRIS HUNDLEY
Published September 24, 2005

The head of Medicare had a simple message Friday: Competition works.

The privately run Medicare drug benefit, which goes into effect Jan. 1, has attracted dozens of players, eager to provide discounted prescriptions for America's 43-million seniors and disabled. The federal government will pick up the tab of an estimated $720-billion over the next 10 years.

In Florida, people who want to stick with traditional, fee-for-service Medicare for their medical care will be able to select from among 18 stand-alone drug plans.

For those who want to enroll in a managed care plan offering discounts on everything from doctor care to pills, there is wider choice.

Two insurers, Humana Inc. and United Healthcare, will offer preferred provider plans statewide that have drug coverage plus a broad network of medical caregivers.

Twenty-six companies will offer Medicare HMOs with drug coverage in areas throughout the state. The Centers for Medicare and Medicaid Services, or CMS, could not say Friday how many of those plans would be available in the Tampa Bay area.

Friday's announcement quantified for the first time how the private insurance and drug brokerage market has responded to the new Medicare drug benefit. Details of the individual offerings, however, will not be available until marketing begins Oct. 1.

"Costs are coming in lower and benefits are better than expected because of strong competition," said Dr. Mark McClellan, CMS administrator. "Plus, every state is going to have drug plans available, even stand-alone plans, with premiums under $20. However you chose to get Medicare, there will be important opportunities to get savings."

In Florida, four of the stand-alone plan sponsors will have an option with a monthly premium of less than $20. Medicare had previously estimated monthly premiums would be about $35.

The deal will be even better through 23 of the Medicare Advantage sponsors in the state: They will offer at least one option with no additional premium for drugs.

Also announced Friday were the names of the companies that qualify to receive the so-called dual-eligibles - people on both Medicare and Medicaid. This population of 6.3-million will be automatically assigned to one of the designated companies, with no monthly premium for the enrollee. The beneficiary will then have the choice of changing plans or remaining in the government-assigned plan.

CMS' McClellan was clearly pleased by the breadth and variety of private drug plans that will be available to Medicare beneficiaries starting Jan. 1.

He also said the government is making progress in getting low-income seniors, who do not qualify for Medicaid but are eligible for extra drug discounts, to take a critical first step: verifying their eligibility with the Social Security Administration.

People with yearly incomes up to $14,355 can qualify for the subsidy ($19,245 for a couple). Roughly one-third of the Tampa Bay area's 500,000 Medicare beneficiaries fall below those income levels. An estimated 6-million people nationwide are expected to meet the subsidy criteria.

Social Security has received more than 3-million applications for the low-income subsidy program, McClellan said. The subsidy will cover most of the costs of monthly premiums, annual deductibles and prescription co-payments.

Friday's press conference was part of a carefully staged marketing campaign for the biggest change in Medicare's history. Starting Oct. 1, seniors should expect to be deluged with ads, mail and phone calls from plan sponsors, touting their offerings. By mid October, Medicare will offer assistance, by phone and on the Internet, as beneficiaries sort through their dozens of options.

"If they tell us what drugs they take and what pharmacies they want to use, we'll help guide them to the plan choices that are a good fit," McClellan said.

And Medicare's head wants everybody involved in the discussion, especially younger family members who might help older relatives decipher plan details. A special insert in the Sunday edition of Parade magazine will encourage families to discuss the Medicare drug benefit over the Thanksgiving holiday. People can begin to enroll in the plans Nov. 15.

"In the weeks ahead, people have to make a choice," McClellan said. "We want people to have conversations about the new drug coverage. We're saying, "America, pull up a chair. It's time to talk about Medicare.' "

Kris Hundley can be reached at hundley@sptimes.com or 727 892-2996.

[Last modified September 24, 2005, 01:17:48]