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Another look at Medicare Part D drug program

By SHEILA REED
Published November 29, 2005

It has been two weeks since Medicare began enrolling beneficiaries in the new Part D drug program. If you are one of Medicare's 43-million beneficiaries who has already enrolled, good for you. You can sit back and wait for your coverage to begin Jan. 1.

If, however, you are one of the people who has more questions than answers, that's understandable. Medicare has made massive changes to its prescription drug policy. You have until Dec. 31 to enroll if you want coverage to begin Jan. 1.

Now, if you really don't want to enroll this year, make a note that May 15 is the last day to pick a drug plan without penalty. Is there an advantage to waiting? Maybe. Maybe not. If you wait to sign up, Medicare may be able to smooth out the kinks in the system, which could mean fewer enrollment headaches. On the other hand, you will not receive savings on your prescription drugs until you enroll.

On Sunday the St. Petersburg Times will publish a special supplement with more Part D information, advice on how to navigate Medicare's enrollment process online and via phone, plus stories from seniors who have already enrolled. Florida has 19 companies offering 43 Medicare drug plans, and that doesn't include the numerous HMOs and PPOs available. In the meantime, here is information to keep handy as you continue to research options.

By now you should have received The Medicare & You 2006 booklet that lists information about drug plans and company phone numbers. The people at 1-800-MEDICARE - that's toll-free 1-800-633-4227 - should give you a list of the three cheapest plans based on your medications. Or you can research that directly at www.medicare.gov Florida's SHINE program can give one-on-one advice if you call toll-free 1-800-963-5337. Expect to leave a message, but a SHINE volunteer will call you back.

The company negotiates discounts from drug manufacturers and resells to you, usually at a below-market price. You will pay a monthly premium to the company and receive a drug plan card to show your pharmacist when you fill prescriptions. The company will charge you an annual deductible, if any, and copayments. Medicare will reduce these costs by subsidizing the company for serving you.

Your costs will vary widely from plan to plan. Premiums in Florida range from $10.95 to $104.89 a month, deductibles from $0 to $250 a year. Often coverage ceases when total drug costs hit $2,250, then begins again when total costs hit $5,100. Copayments can range from no cost for a 30-day generic to $75 for a brand-name drug. Plans with broader coverage charge higher premiums.

If you want to get your hospital and doctor care through a Medicare HMO or PPO, it will also provide your drug coverage, and usually more cheaply than traditional Medicare. Part D drug plans only accompany Medicare's traditional Parts A and B, where you pick your own doctors and hospitals. Warning: You can't have a Medicare HMO and a Part D drug plan. If you sign up for both, Medicare will disenroll you from the HMO and put you on traditional Medicare Parts A and B.

If you want to join an HMO or PPO, contact them directly. If you want to add a Part D drug plan to traditional Medicare Parts A and B, you can contact the private drug plan directly or sign up online at www.medicare.gov or by calling 1-800-MEDICARE toll-free 1-800-633-4227.

If you take very many medications, be wary of picking the plan with the lowest premium. You often can save money by paying more for broader coverage. Make sure the company includes your drugs on its formulary and will let you use the pharmacy of your choice. Many plans require prior authorization or restrict prescription quantities for some drugs. Ask each company if they restrict your drugs and how. Consider paying a slightly higher premium for a plan with fewer restrictions on your specific drugs.

It had to come to an end and it will on Dec. 20. That's the last day the Times Remembered series will appear in Seniority. After two years and more than 20 writers the memories have been wonderful, but it's time to make some new memories. Stay tuned for more details.

Sheila Reed, Seniority editor, can be reached at 727 893-8452 or toll-free 1-800-333-7505, ext. 8452. Write to her in care of the St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731; or send e-mail to sreed@sptimes.com

[Last modified November 23, 2005, 14:10:37]