Ready or Not, Here Comes the Medicare Prescription- Drug Benefit
By Andy Humm
You have a big decision to make this fall, and it’s not at the ballot box. In October, the government and private insurers will begin flooding your mailbox with information about how to make the difficult choice between whether or not to enroll in the new Medicare drug-benefit program, and which of several plans is best for you. You can enroll as early as November 15 and begin receiving benefits as early as January 1. But failure to make up your mind by May 15, 2006, will subject you to higher costs if you decide to sign up down the road.
“The drug plans are a real pill,” says Amy Paul, executive director of Friends and Relatives of the Institutionalized Aged (FRIA) here in New York. “They may be helpful, but the requirements may be hard to swallow. When we start to explain it, people start to feel overwhelmed. You have to pick through a lot of information that doesn’t apply to you.”
Tom Smith, RN, of the Visiting Nurse Association, is especially concerned about his poorer clients who receive both Medicare – for older and disabled people – and Medicaid, for the poor. “It is confusing even for better-educated people,” he said in mid-September. “Nothing has gone out. We’re a health-care provider and I haven’t seen any guidelines.”
It is so complicated that Senator Hillary Clinton’s office has published a 31-page booklet to explain the intricacies. (See: Resources.)
In 2003, Congress passed the Medicare Prescription Drug Im-provement and Modernization Act, which the government Website calls the most “dramatic” change since Medicare was instituted in 1965. But it was so controversial that Republican leaders kept the vote open in the House for hours until they and George W. Bush could twist enough arms to get it passed.
Fiscal conservatives resisted the program because it is hugely expensive and the federal deficit is already at record heights.
Liberal legislators see it as a first step toward privatizing and ultimately destroying Medicare.
Representative Jerry Nadler (D-NY), who opposed the 2003 bill, said: “The Republicans wanted to respond to the tremendous pressure from the country and Democrats for a prescription-drug benefit, but didn’t want to take away profits from the pharmaceutical companies who are among their biggest contributors. It’s a mishmash of gifts to them and the insurance companies. And it prohibits the government from using its power to make bulk purchases of drugs to reduce costs.”
Pfizer, the drug giant, has hired former Senator Bob Dole, who opposed the creation of Medicare in 1965, to go around the country promoting the prescription benefit.
Nadler says the law gives companies that are paying for prescriptions for their pensioners an incentive to drop their coverage to Medicare levels, which he calls “skimpy,” and still collect a payoff from the government for not dropping it entirely. He has introduced legislation to compel such companies to maintain their benefits.
More than 95 percent of older Americans signed up for Medicare in 1965. Federal officials are predicting that 30 million of today’s 42 million beneficiaries will enroll in the drug plan. AARP has reported. Those also on Medicaid and in nursing homes will be forced to.
In addition to worrying about which plan to pick, you have to be aware that scammers are already out there trying to trick people into enrolling in plans that are not approved by Medicare. This may just be a ploy to acquire all your personal data so as to commit identity theft.
Under the law, a choice of at least two plans is supposed to be offered in every state, although many more could compete for your business. While the initial estimate of monthly premiums was in the $37 range, the Department of Health and Human Services is claiming that “competition” is driving that cost as low as $20, with as little as a $250 deductible. We’ll see what kind of coverage that will provide.
Which plan you choose will depend on your economic status, how much you are willing to pay, whether you are already enrolled in a private plan or Medicaid, and what kinds of drugs you take. Different plans will cover different drugs. Since you can’t anticipate what kinds of drugs you’ll need in the future, you’re given the option of changing plans once a year.
One of the odd features of the program is that you get coverage for the first $2,000 worth of drugs, then none for the next $3,100 worth – after which point coverage resumes. If, however, you are at the poverty level (which differs as between singles and couples), you can avoid premiums and co-pays entirely, or pay much lower ones.
The best advice is to start familiarizing yourself with the program and its implications for you now, write down any questions you have, let a friend or family member help you if you feel confused, and turn to one of the listed resources for further clarification.
RESOURCES
AARP, which lost thousands of members when it came out in favor of this Medicare Part D plan, is doing its best to explain. It has lots of information at www.aarp.org, including links to other resources. You can also call them: 888-OUR-AARP (888-687-2277) on weekdays.
The official Medicare website, www.medicare.gov, will offer comparisons of your options starting October 13. You can also call 800-MEDICARE (800-633-4227) to get printed copies of guidebooks.
Locally, Friends and Relatives of the Institutionalized Aged will have information on its Website (www .FRIA.org). This resource is especially useful if you or a loved one is in long-term care. Its helpline is (212) 732-4455.
You can call the New York advocacy group, State-Wide Senior Action Council, for advice at (212) 316-9393. Its Website is www. NYSenior.org.
HIICAP, the Health Insurance Information Counseling & Assistance Program of the New York State Office for the Aging is at www.HIICAP.state.ny.us. Its New York City phone number is (212) 333-5511
Senator Clinton’s guide is available by calling her office at (212) 688-6262 or visiting: www.clinton. senate.gov.
The Medicare Rights Center is the largest independent source of help for people on Medicare. It can be reached at (212) 869-3850. But for lengthy explanations of the program, visit www.MedicareRights.org.
