How to Pick a Plan
Lipitor. Nexium. Plavix. Fosamax. You know that slew of pills you take every day? They're going to help drive your choice of a Medicare drug plan
Even if your current drug plan meets the minimum standard, you might be able to find a Part D plan that is better. It can't hurt to take a look at some of the plans available in your area and compare them with your current coverage and out-of-pocket costs. Again, as long as your plan is creditable, you can do this at your leisure. Try asking friends in six months or a year and seeing how they like their plans.
For those covered by Veterans Affairs or Federal Employee Health Benefits plans, your coverage won't be affected and you'll not likely need to enroll in the new plan because your coverage is already comprehensive. If you already have drug coverage through a Medicare private health plan like an HMO, you can stay in that plan if the coverage meets your needs.
You have a Medigap policy
If you have Medigap, a supplemental Medicare insurance policy, and it covers drug costs, you have choices. You can keep your plan, though in most cases it won't meet the government creditable hurdle. Many people may have to pay a penalty if they enroll in Part D later on. Other options: Keep your Medigap policy and cancel only the drug benefit, then sign up for Part D. You can also leave your plan and join a Medicare private health plan that includes Medicare drug coverage. Those with Medigap should receive a letter this fall about what the new drug benefit means for their existing plans.
You receive state assistance
Some seniors receive help through a state pharmaceutical assistance program, or SPAP, like EPIC in New York or Circuit Breaker in Illinois. How those programs mesh with Medicare Part D is up to individual states. Some may opt to discontinue their programs, while others will work with the primary Medicare benefit (filling in gaps in coverage, for example) or continue to offer existing coverage. If you're part of one of these programs, your state should notify you of any change in benefits.
You have a very low income
Seniors with incomes below 150 percent of the poverty level and few liquid assets should definitely sign up for a plan, say consumer advocates. That's because these folks qualify for so-called extra help, which means they will have low or nonexistent premiums and deductibles and lower copays, though they're often restricted to basic plans. Trouble is, tapping into the extra help isn't effortless. Those on some government aid programs like SSI automatically qualify, and if they don't sign up for a drug plan by May 15, 2006, they'll be randomly assigned one next spring.
Others can apply for the extra help (remember, this is separate from signing up for a Part D plan) with the Social Security Administration (ssa.gov or 800-772-1213) or their local Medicaid office (cms.hhs.gov/medicaid/consumer.asp) . SSA, in fact, sent out about 17 million letters this year to those it deemed eligible for extra help and has received more than 3 million responses, McClellan says. The letter might have been misunderstood, as were some of the responses. "Some people applied for extra help, got a mailing that said they weren't eligible, and assumed that meant they weren't eligible for the benefit," says Laura Caruso, director of medical health policy at the Gay Men's Health Crisis in New York.
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