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
Low-income seniors need to be proactive. Save every piece of government mail you receive, and contact a State Health Insurance Assistance Program (SHIP) or a community group, which can provide information on both the extra help and Part D plan choice. A portion of income and liquid assets like a home are excluded from the government cap, so even if your income is more than the cap, you may qualify for the extra help.
You have Medicaid
The group that has consumer advocates most worried consists of "dual eligibles," people who are eligible for both Medicare and Medicaid. Medicaid coverage varies from state to state but is quite comprehensive. But dual eligibles are being funneled into the new Medicare benefit, which doesn't have the same protections. And this change will happen literally overnight. "The faucet's off December 31," says Robert Hayes, president of the Medicare Rights Center, a national nonprofit. "And the issue is whether Medicare coverage will be as good as Medicaid."
Dual eligibles will have very low copays and low or no premiums at all. Depending on the state, Medicaid may step in to pick up other out-of-pocket costs like drugs not covered by the plan. Dual eligibles will be automatically assigned a plan this fall if they don't sign up, and there's no guarantee their specific drugs will be covered. Advocates worry that on January 1, there will be pandemonium about the switchover, and some people will lack necessary drugs. Caruso says that dual eligibles need to understand that Medicare will be their primary coverage and Medicaid or other assistance programs, like AIDS Drug Assistance Programs (ADAP s), will be secondary. "Do they know to take out their Medicaid and ADAP cards if Medicare Part D is denied?" she wonders.
Some people who have studied Part D have already decided to stick with what they've got. Jim and Jackie Shelton are keeping their supplemental insurance policy, because it helps make up the difference between their medical costs and what Medicare covers--and it also pays for some of their prescription drug expenses. "They negotiate a pretty substantial discount from thousands of pharmacies, national chains, and local ones," says Jim, a retired printing industry executive in Pennington Gap, Va. That's important, since Jim has diabetes and prostate problems and Jackie suffers from arthritis. He doesn't think the Medicare drug plan would be cost-effective for them.
While all the ins and outs of this new benefit are confounding, experts urge seniors not to become overwhelmed. "We don't want people to agonize over making the perfect decision," says AARP's Matheis. "A number of different plans will meet the person's need." A lot of choice can go a long way.
JAN. 1, 2006
The new Medicare Part D prescription drug coverage takes effect.
MAY 15, 2006
The first Medicare Part D enrollment period ends. Later sign-up may incur a penalty.
With Josh Fischman
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