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Special coverage: Medicare

Find your way before decision day

The complexity and abundance of Medicare Part D drug plans can be daunting. Don't wait until the May 15 deadline to get the help you need.

By TOM VALEO
Published April 25, 2006

	[Times photo: John Pendygraft]
	Harold Densmore, 89, talks with an elderly woman who called in with questions about the Medicare drug benefit program. Densmore, who works from a small office in St. Petersburg, is the local coordinator with the SHINE program, which helps elderly people with questions about insurance.

If you're older than 65 and haven't signed up for Medicare's Part D drug coverage, do so now. After May 15, the cost of your premium will rise 1 percent each month, and you will not be able to sign up again until Nov. 15.

"People will say to me, 'I'm healthy; I'm not taking drugs at all. I don't need a drug plan'," said Harold Densmore, a volunteer with SHINE (Serving Health Insurance Needs of Elders), who counsels people confused by Part D.

"I advise them to buy the cheapest plan possible - $10.35 a month - because then at least they're insuring themselves against the penalty (for not signing up)."

People who sign up by May 15 - just three weeks from now - can change plans without paying a penalty, between Nov. 15 and Dec. 31 each year.

If you are older than 65, you can ignore the deadline next month if you fall into one of three categories:

n You already have drug coverage through an insurance plan that is "creditable," the word used to signify that this coverage has a drug plan at least as good as Medicare's. If you lose your insurance coverage later, you can sign up for Part D without penalty.

n You are "dual-eligible," which means you qualify for Medicare and, because of low income, you also qualify for Medicaid.

n You enroll in a Medicare HMO, known as Medicare Advantage. There are about 30 such HMOs and PPOs in Pinellas, Hillsborough, Pasco, Citrus and Hernando counties, offering about 100 plans. "But a lot of people don't like them because they're restrictive in terms of the doctors and hospitals you can go to," Densmore said. "But if you pick an HMO, it already has a drug plan. It's a 'creditable' plan."

Checking out your options

If you don't fall into any of these categories and if you have not signed up for a Part D plan, as of May 15 you will start to incur the 1-percent-per-month penalty on the Part D premium you ultimately do select.

The problem with signing up for Part D, as an estimated 27-million people have already discovered, is that understanding the plan and its options can be challenging.

There are at least 49 drug plans in Florida, with many offering two or three subordinate plans. This means that a person who wants to sign up for Part D has more than 100 choices, many of them slightly different from all the others.

"One woman came in with 40 sheets of paper," said Densmore. "She had examined 40 plans and thought she had it all figured out, but she still had picked the wrong plan. You can fail (to make the best choice) in so many ways."

Competition should cause some insurers to drop out, thereby reducing the number of choices, said Roger Perez, acting regional administrator for Medicare's Atlanta region.

"It's complicated, yes," he said of Part D, "and we're looking at how to improve the program, but the great thing is that until now, many Medicare beneficiaries have not had a plan."

Don't be afraid to ask

Once you decide to enroll in Part D, where should you begin?

First, you must determine which plans offer the drugs you need. Then you must look at the price charged for those drugs.

"One plan may charge $22 for a brand-name drug," Densmore said. "Another may charge $66 for the same drug."

Then you must decide if you want to pay a higher premium for more coverage, or a lower premium for less coverage. But figuring the actual cost may not be straightforward.

"For example, some plans offer a mail-order concept," Densmore said. "They say you can buy a three-month supply of drugs for the cost of two months. But examine it closely and you'll find that . . . you don't get it for the cost of a two-month supply. It looks good, but it's not good. Some of the programs I would turn up my nose at."

The complexity of Part D has caused hundreds of people to seek help from Densmore and the 42 other SHINE volunteers.

"We get referrals every day of week from Social Security, Medicare, Medicaid, doctors' offices, pharmacies," Densmore said. "They all say, 'Call SHINE.' We do know more than rest of them because we do it all the time."

Freelance writer Tom Valeo specializes in medical

and health issues.

[Last modified April 25, 2006, 15:42:18]