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Special coverage: Medicare

Medicare Part D drug plans: It's decision time again

The pros: Medicare drug benefits in 2007 may be larger. The cons: The choices remain dizzying. So, head for the help.

By KRIS HUNDLEY
Published October 31, 2006

Let the full-page ads, mailers and free-lunch offers begin. Ready or not, on Nov. 15 millions of Medicare beneficiaries will have the opportunity to select a new drug-benefit package for 2007. And the options promise to be even more numerous - and confusing - than in 2006.

For people who want traditional Medicare for their health coverage, 58 stand-alone drug plans will be vying for their prescription business.

And for those who want medical and drug coverage combined in an HMO-like plan, insurers will be offering dozens of Medicare Advantage options in the Tampa Bay area.

Harold Densmore, a counselor in St. Petersburg with the SHINE program that helps people sort through Medicare choices, knows what lies ahead. "It's gonna be a headache," he said.

On the plus side, some plans are offering richer benefits than last year, including generic as well as a limited number of brand-name drugs in the coverage gap.

The cost of drug coverage under Medicare Advantage plans is also estimated to be about $6 a month lower, on average, nationally in 2007 than in 2006.

On the negative side, the options can be dizzying as people try to figure out which plan gives them the best deal on their prescription needs.

But help is free and plentiful. Beneficiaries can get in touch with a SHINE counselor by calling toll-free 1-800-963-5337. Or they can use Medicare's Web site (www.medicare.gov) to navigate through the options, or call toll-free 1-800-633-4227.

Bob Archer, area director for the Pasco and Pinellas counties SHINE program, said that careful selection will be critical because, for the first time, beneficiaries will be locked into the plan for the entire year. The only exceptions are people on both Medicare and Medicaid; they are allowed to change plans monthly.

People who are happy with their current insurer - and willing to accept any of its plan changes for 2007 - have the option of doing nothing. Beneficiaries who take no action before the end of the year will automatically be re-enrolled in their 2006 plan.

But if a recent survey by J. D. Power & Associates is any indication, the do-nothing group will be small. Only 20 percent of the 3,400 people surveyed said they would definitely stay with the plan they had in 2006.

A word to the wary

While insurers will be adding all kinds of bells and whistles to attract members, two program-wide changes are worth noting:

- The so-called doughnut hole will be slightly smaller next year. The level at which people reach this gap in coverage has been raised slightly, to $2,400. At that point, federal subsidies stop until a total of $3,850 has been spent in out-of-pocket expenses.

- Also increasing is the benchmark for low-income assistance. Individuals with incomes of less than $14,700 and couples with less than $19,800 may qualify for free drug coverage. And people whose incomes are even lower ($13,470 for singles, $18,048 for a couple) may qualify for assistance with their Part B Medicare payment. More information on both programs is available through either SHINE or Medicare.

SHINE counselors warn that participants should make sure they are aware of any restrictions on their choice of doctors, hospitals or drugs before enrolling in a plan.

Alex Funtukis of Clearwater learned the hard way. The 81-year-old thought he was just getting help with his expensive prescriptions when he signed up last year with Universal Health Care. Instead, he unknowingly enrolled in a managed-care plan that restricted his selection of doctors, charged him for an ambulance ride and didn't cover critical items such as his glucose testing strips for diabetes.

"When I hit the doughnut hole after four-and-a-half months, I decided to drop out," Funtukis said. "But it took nearly three months to get back on regular Medicare."

Fast facts:

Tips for enrolling in Medicare's prescription drug program:

- Be aware that a Medicare Advantage program is not traditional Medicare, which allows you to go to any doctor or hospital of your choice. Medicare Advantage programs do offer a broad range of services, but they have certain restrictions on both providers and drug choices.

- If you want to stay in traditional Medicare, enroll in a Stand-Alone prescription drug plan, or PDP.

- You may have forgotten, but there is no such thing as a free lunch. If you attend a meal sponsored by a Medicare insurer, expect an aggressive sales pitch from commissioned sales people.

- If you call Medicare for help 1-800-663-42273, you can shorten your wait for an operator by saying the word "agent" during the recorded message.

- Though you might want Medicare's representative to discuss your options with you on the phone, also ask the agent to send the choices to you in writing.

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

[Last modified October 31, 2006, 12:42:15]