Companies offering Medicare drug plans next year start their sales pitches. Don't be discouraged by the barrage.
By STEPHEN NOHLGREN and KRIS HUNDLEY
Published October 1, 2005
Medicare's much-awaited drug coverage doesn't start until Jan. 1, but the marketing free-for-all begins today.
Eighteen private drug plans and a half-dozen Medicare HMOs can now take to the airwaves and fill up mailboxes, trying to woo Tampa Bay's older and disabled residents with their wares.
Will the drug benefit be a good deal?
Almost certainly. Congress is shelling out more than $700 per person a year to underwrite coverage. Unless people already have great drug insurance, one of the new Medicare plans or HMOs probably will suit them.
Will it be confusing?
Absolutely. Premiums, copayments and deductibles vary widely among plans.
Where can you get help?
Government agencies and advocacy groups are gearing up to give one-on-one advice. The St. Petersburg Times will publish numerous stories over the next three months.
When does the Medicare drug coverage start?
Actual coverage begins Jan. 1. But you can start signing up for a plan or HMO as of Nov. 15. In about two weeks, Medicare will mail you a pamphlet called Medicare & You , which will compare the stand-alone plans and HMOs available in the Tampa Bay area. That gives you time to weigh options before the signup period begins. If you sign up before the end of the year, coverage can start Jan. 1. After that, you still have until May 15 to sign up, but you won't get coverage until you do.
Why is today an important date?
As of today, stand-alone drug plans and Medicare HMOs can start marketing their programs, with details about prices and coverage. Expect lots of mail and TV advertising. It might be a good idea to save the mail so you can compare plans side by side.
How do I get prescription drug coverage?
In two distinct ways. If you use Medicare's traditional Parts A and B, where you choose any doctor or hospital you want, then you can enroll in a separate, stand-alone drug plan. This is Medicare's new Part D. If you want to belong to a Medicare HMO or PPO - sometimes called "Medicare Advantage" - you will receive your drugs through the HMO or PPO.
Who runs these stand-alone drug plans?
Health care and insurance companies, including giants such as Aetna and Blue Cross and Blue Shield. Medicare will pay them for each person they serve. The plan sponsors will negotiate discounts from drug companies and collect your Part D premium and copayments. Several companies, including Humana and WellCare, also operate Medicare HMOs, so make sure you know what you are signing up for.
What will drug coverage cost?
Get ready for choices. Premiums for stand-alone drug plans range from Humana's $10.35 a month to Universal Health Care's $104.89. The higher the premium, the more coverage you tend to get. Deductibles range from zero to $250 and copayments vary widely. Some HMOs and PPOs charge no premiums or deductibles. The Part D drug premiums are in addition to Medicare's regular premium that comes out of your Social Security check, which will be $88.50 next year.
These choices sound confusing. How can I pick a drug plan or HMO that is right for me?
First, make sure that any stand-alone plan or HMO actually covers the drugs you take or their medical equivalents. Not every drug is covered by every plan. Second, estimate your out-of-pocket costs over the course of a year under different plans, including premiums, copayments and deductibles. Keep in mind that plans probably will offer drugs more cheaply than you now pay because they can buy in bulk. In about two weeks, Medicare's toll-free hotline, 1-800-633-4227, will be staffed with government workers who will help you pick a plan based on what you can afford and the drugs you take. Web sites and advocacy groups will do the same. (More information below.)
What if I'm on a Medicare HMO right now?
You will soon get a letter from your HMO explaining the plan's 2006 benefit. If you do nothing, you will be re-enrolled in the same HMO for another year. If you want to switch to another HMO or move to traditional Medicare, you should do so between Nov. 15 and Dec. 31 so coverage can start Jan. 1. Warning: If you want to stay on your current HMO, do not sign up for a stand-alone drug plan. Medicare might disenroll you from the HMO.
Can I still use my neighborhood pharmacy?
That depends. Some stand-alone plans and HMOs will restrict you to certain pharmacies or mail-order houses. If shopping at a particular pharmacy is important to you, make sure a plan or HMO will work with your pharmacist.
I'm healthy. Must I get drug coverage?
No. Just like Part B doctor coverage, the new Part D drug coverage is optional. However, if you reject coverage now, Medicare will charge a penalty if you change your mind later. Monthly premiums will rise 1 percent for each month you reject coverage. Many experts say that you should treat drug coverage like life insurance: If you can afford the premium, sign up now, when the premiums are low. Also, some plans will offer premiums under $20 a month. That's a pittance compared to the thousands of dollars that drugs could cost for a serious illness.
What if I can't afford the premiums?
If you qualify for Medicare and already receive drugs through Medicaid or state assistance programs, you will automatically be enrolled in a stand-alone Medicare plan without having to pay premiums or large copayments. As of Jan. 1, Medicaid will no longer provide drugs to people who also qualify for Medicare. Even if you are not on Medicaid, you might qualify for reductions on premiums, deductibles and copayments if your income falls below $14,356 ($19,246 for a couple) and you don't own a lot of liquid assets such as savings, CDs and stocks. For more information on low-income assistance, call Social Security toll-free at 1-800-772-1213.
My spouse's income is low, but mine is high. Can she qualify for low-income assistance?
No. If you are married, your incomes will be evaluated as a couple.
Will manufacturers still offer free drugs?
Maybe not. For years, most pharmaceutical companies have offered free or cheap drugs to low-income people. These "patient assistance" programs may disappear after Jan. 1, industry representatives say. Be alert for mailings from any drug company that is now providing you with free drugs.
Will my Medicare drug discount card still work?
Not after Jan. 1.
What if I get retiree drug benefits from my ex-employer or union?
You can keep retiree drug benefits and later switch to a Medicare drug plan without any penalty, as long as your retiree plan offers "creditable coverage," meaning that it is at least as good as Medicare's new coverage. Your ex-employer or union should send you a letter by mid November saying whether your retiree plan qualifies as "creditable coverage." If it is not creditable, you probably should switch to a Medicare HMO or stand-alone drug plan to avoid paying a premium penalty later on. You might also want to switch if you meet Medicare's low-income and asset tests. That probably will make Medicare's plans cheaper than your retiree plan.
If I choose a plan and don't like it, can I change later?
Most Medicare beneficiaries will have one chance to change stand-alone plans or HMOs before May 15. After that, they will be locked in for the remainder of the year. People who qualify for a low-income subsidy can change as often as they like. At the end of each year, you will get another chance to make these choices all over again for the following year.
What should I do if someone comes knocking on my door, trying to sell one of these plans?
Medicare allows telemarketing, but not door-to-door cold calls. Unless you have invited someone to your home by appointment, the salesperson is breaking the law. Call Medicare toll-free at 1-800-633-4227 and complain. Do not give out personal information over the phone. If you want to sign up with a plan or HMO, have them mail you the literature, or sign up through Medicare's hotline.
