Area News | Home | Marketplace | Community

Return to Archived Stories

Paynesville Press - November 9, 2005

Medicare to offer new drug coverage to seniors

By Michael Jacobson

The sign-up period for Medicare Part D, prescription drug coverage for seniors, starts next week.

Seniors, whether they currently use prescription drugs or not, should consider their options under the new program.

Many people have questions about Medicare Part D, according to Bert Stanley, a pharmacist in Paynesville for 30 years, and to Todd Lemke, a doctor of pharmacy (Pharm.D.) at the Paynesville Area Health Care System.

It essentially is a government-backed insurance plan. Seniors will actually get this insurance through Medicare-approved private insurance plans.

Despite its complexity, it is the "best program yet" for seniors, said Dorine Fuchs, a state certified volunteer health insurance counselor for Senior Linkage in the Paynesville area.

Fuchs and Lemke will host a talk about Medicare Part D on Thursday, Nov. 10, at 2 p.m. at 700 Stearns Place.

The standard plan under Medicare Part D calls for seniors to pay 100 percent of their first $250 in annual drug spending (a yearly deductible); then 25 percent of next $2,000 (totaling $500); 100 percent of next $1,850 (the so-called "donut hole"); and five percent of costs after $5,100 (catastrophic coverage).

The majority of seniors in the Paynesville area have yearly drug costs in the $1,000-$2,000 range, estimated Lemke, and will be able to save 50 to 60 percent on their drug purchases. Only 10 or 20 percent might approach the "donut hole," with annual drug costs between $2,000 and $3,000, said Lemke. These seniors could still save 50 percent on their drug costs.

For seniors with significant drug costs, the question is which plan to join. For starters, seniors need to gather information about what drugs they take, in what amounts, and what dosages. Then they need to figure how much they currently pay for these drugs.

This information will be critical when they compare plans under Medicare Part D. Medicare has set up a website - at - for seniors to compare the different plans based on their drug needs, said Lemke, but this may not be ideal for seniors who are not computer savvy. (As part of his talk on Thursday, Lemke will demonstrate the website for seniors.)

Seniors may need help from a child or guardian to choose the best plan for them. They can also call Medicare at 1-800-MEDICARE (1-800-633-4227) or the Senior Linkage at 1-800-333-2433 for phone assistance.

While the sign-up for Medicare Part D begins on Tuesday, Nov. 15, the actual drug coverage doesn't begin until Jan. 1, 2006.

While some insurance plans will be considered "credible" under Medicare Part D, the drug discount cards will end, along with Medigap drug coverage. Anyone with current drug coverage - from an insurance plan or through a union - should get a letter notifying them of how their current coverage compares with the new Medicare Part D requirements. These letter should be sent by next week.

According to Medicare, seniors choosing an insurance plan should consider three factors: cost, coverage, and convenience. Cost is what you pay, including premiums, deductible, and co-payments. Coverage is the drugs you need versus what you get under the plan. And convenience is which pharmacies are part of the plan.

Choosing wisely is important, because seniors will be locked into a plan for most of the year. The window to change plans under Part D will be limited from Nov. 15-Dec. 31 in subsequent years.

Even seniors who do not take significant drugs currently and can manage their drug expenses without the help of insurance should consider joining a plan, Fuchs, Lemke, and Stanley agreed.

The initial sign-up period for Medicare Part D runs from Nov. 15, 2005, to May 15, 2006. Seniors who are eligible, who do not have another "credible" coverage, and who do not sign up will face a penalty if they want to sign up later.

The penalty is one percent of the monthly premium for each month deferred, and it is a permanent penalty. In five years, that would amount to a 60 percent increase in the premium price, which is likely to increase already, said Fuchs.

While the average monthly premium is expected to average $37, Fuchs and Stanley said that they have seen rates for a "credible" plan as low as $13 per month. Still, deciding if you should start paying unnecessary premiums or risk paying a penalty later is a "crapshoot," said Stanley, because no one knows what drug needs you might have in the future. Someone might be healthy now and have a heart attack in a few months and then have major drug needs.

"That's why seniors are throwing their hands up," said Stanley.

Drugs for hospital patients are covered by Medicare Part A, and patients can change their Medicare Part D plan if they move into a nursing home, said Lemke. Furthermore, if a plan does not cover a drug that you take, your insurance plan must provide a 60-day supply, said Lemke. This gives you time to get an appointment with your doctor and see if there is another medication on their plan that could be substituted.

While the yearly deductible starts on the first of January, which should give seniors an incentive to sign up before then, according to Stanley, "People don't have to sign up next week," warned Lemke. While the sign-up period begins next week, seniors have plenty of time to gather information, evaluate their choices, get help if needed, and make the right choice.

Seniors with limited income and resources may qualify for extra assistance. To qualify, seniors must have an annual income below $14,355 for a single person or below $19,245 for a married couple and resources (including savings and stocks but not counting the value of your home or car) less than $11,500 for a single person and less than $23,000 for a married couple.

These seniors can call Medicare at 1-800-MEDICARE (1-800-633-4227) or the Social Security Administration at 1-800-772-1213.

Contact the author at   •   Return to News Menu

Home | Marketplace | Community