As Medicare's Part D drug coverage begins, you'll need to do your homework to make a choice that best - and most affordably - meets your needs.
By STEPHEN NOHLGREN, Times Staff Writer
Published December 4, 2005
[Times photo: Douglas R. Clifford]
John Bowles, 70, of Palm Harbor, plays with his granddaughter, Jessica Nesbit, 5, at a Clearwater Park. Bowles has picked a plan that will cut his monthly medication costs from $943 to $224. He plans to put $350 of the savings into a fund for Jessica's college education.
Read profiles of eight people who shared their experiences with the Times
Love it or hate it, Medicare's new patchwork drug coverage is hard to ignore.
It's the biggest transformation in coverage since Medicare began.
The Bush Administration, which has considerable political capital invested in its acceptance, is spending $100-million to help people understand it and make their choices.
Private insurance companies, which will administer the new "Part D" drug plans as well as beefed-up Medicare HMOs, are sending out informational vans, buying television ads and staffing booths at senior expos.
With a 10-year price tag of $800-billion or so, some politicians are suggesting that it ought to be delayed a year or more, because the country can't afford it.
Weighty matters indeed. But for most of the 43-million Americans and 500,000 Tampa Bay area residents who rely on Medicare, the drug issue comes down to one question: What does it mean for me?
This special section is designed to help people resolve that question, which rarely has an easy answer.
In Florida, Part D has 19 companies offering 43 drug plans. Premiums range from $10.35 a month to $104.89. Formularies cover some drugs, but not others. Then there is the "coverage gap," or more informally, the "doughnut hole," or "Krispy Kreme," a financial Bermuda Triangle that can swallow coverage when total drug costs are more than $2,250 and less than about $5,100 a year.
Medicare's Web site contains a list of more than 1,000 "frequently asked" questions about the program.
Complications aside, there is much to like about these drug provisions - at least from a beneficiary's standpoint.
Medicare is going to pay the insurance companies $700 a year for everyone who signs up for a drug plan. That underwrites a lot of drug-buying and still leaves room for profit. Unlike most insurance - where premiums and copayments cover the risk - this benefit is financed largely by taxpayers, not by the contributions from individual Medicare beneficiaries.
Humana's Standard plan carries a premium of $10.35 a month. Coventry Advantra, PacificCare and WellCare all have plans under $20. At those prices, even beneficiaries who take no drugs will usually benefit from signing up. If they suddenly have an illness, they will quickly earn back the premium. And if their health declines later in life, they can get cheap drugs without paying a stiff premium penalty.
Many low-income people who blanch at a $20 premium can qualify for "special help." This subsidy reduces premiums, deductibles and copayments. Yearly out-of-pocket drug costs will average $130 for those people.
By adding hundreds of thousands of Medicare clients to their rolls, the drug plans can buy in bulk and negotiate discounts from pharmacies. Discounts will come in handy when beneficiaries enter the "coverage gap" and have to pay 100 percent of costs.
The new Medicare also improves HMOs and PPOs.
Their clients cannot enroll in separate Part D drug plans, which are designed to supplement Medicare's traditional parts A and B. However, Medicare is also increasing payments to HMOs, to help them stay competitive. In return, the HMOs must enhance their drug coverage or other benefits.
Coverage begins Jan. 1 for both the drug plans and HMOs. That means most people should probably make a choice by Dec. 31.
So keep this section handy. There is much to absorb. You will find three pages of charts, listing premiums, copayments and other details of Florida's "Part D" drug plans. If you prefer a Medicare HMO or PPO, they are also listed.
Other stories describe how the special subsidies might help low-income people, how drug programs may be coming to an end, and how some drug plans place restrictions on what your doctor can prescribe.
Medicare has a toll-free hotline, designed to help people make choices. One story in this section tells you how to make that call and what questions to ask so you can get the service you need.
We also guide people with computers on how they can do their own research by entering their medications and comparing plans at www.medicare.gov This Web site experienced serious slowdowns in the first days of operation, but appears to be running smoothly. Even so, expect to spend 45 minutes to an hour on a thorough search.
