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Paynesville Press - November 23, 2005

Medicare meeting draws large crowd, many questions

By Michael Jacobson

Over 100 local senior citizens attended an hour-long meeting about the new Medicare Part D (prescription drug coverage) at 700 Stearns Place on Thursday, Nov. 10.

The sign-up period for the new drug coverage began on Tuesday, Nov. 15. The drug coverage begins on Jan. 1, 2006.

Dorine Fuchs, a state certified volunteer health insurance counselor for Senior Linkage in the Paynesville area, Todd Lemke, a doctor of pharmacy (Pharm.D.) at the Paynesville Area Health Care System (PAHCS), and Lois Roback, a social worker at PAHCS, led the meeting, presenting an overview of the new program and answering questions.

While some seniors on medical assistance will be automatically assigned to a drug plan and others with current prescription drug insurance (through a private company, union, or even the Veteran's Administration) can stay on their plan, if "credible," most seniors will need to choose and sign up for new drug coverage, the group was told.

"That's why it's very important to take some time, look at your options, and figure out what is best," said Fuchs.

The federal government is funding the drug coverage through Medicare, but it will be offered through private insurance. A list of insurance companies with Part D insurance in Minnesota was distributed at the meeting.

Though premiums, deductibles, and co-pays can vary from company to company (and from plan to plan within the same company), the basic plan for Part D is a $250 deductible; then the patient paying 25 percent of next $2,000 in prescription drugs in that year; 100 percent of the next $2,850; and five percent of anything over $5,100 (catastrophic coverage).

Like other types of insurance, the higher deductibles might mean lower premiums, etc. More expensive policies, on the other hand, should provide better coverage.

Each plan will have a different list of medicines, or a different formulary, for varying health conditions, said Lemke. Seniors should choose a plan that has the drugs that meet their needs.

The best plan might cover all five drugs you are currently taking or maybe only four out of your five current medications. If you can't find all your medications on the same plan, then you might need a temporary supply of the fifth drug - companies must pay for a 60-day supply - until you can visit your doctor and see if you can switch to a medication that is on the plan, said Fuchs.

A good way to start is to figure what medications, in what doses, you are taking now and how much this costs, including any current drug plan. Then, there are ways to search the plan offerings for the best one for you.

One way to do this search is via the Internet. At, there is a formulary find where the names of drugs and dosages can be entered in order to search for the best insurance plan.

The website also allows searching by pharmacy (if the location of where you purchase drugs is important or if you go south for the winter) and by company.

"It sounds easy to look a little, but there's a lot of looking to do," said one frustrated man.

When Roback asked who needed help signing up, over half the audience raised their hands.

Seniors can sign up at, by calling 1-800-MEDICARE (1-800-633-4227), or by using local resources like Senior Linkage at 1-800-333-2433, which will assist them. They can also get their drug coverage through an insurance agent.

Insurance companies are not allowed to solicit this drug insurance, said Roback, in warning seniors against possible scams. If you call an insurance agent or company, they can call back; but if an unknown agent or company makes contact, be wary, she warned.

Patients also will be able to change their coverage every year during a window from Nov. 15 to Dec. 31. If a senior enters a nursing home, he or she can change plans right away, added Lemke.

Seniors will need to sign up by May 15, 2006, or face a penalty, warned Fuchs. Anyone without a "credible" plan at that point will be assessed a one percent penalty per month if they sign up later. Over five years, this could be a 60 percent premium increase per month.

Even relatively healthy seniors who use few drugs should consider a drug insurance plan to avoid this penalty, urged Fuchs. These drug plans, like any insurance, are a good idea even if not needed now.

Most seniors probably will have some prescription drug needs in future. "As we age, we have to look at the possibility that we're going to use more drugs," said Fuchs.

"It's the first time we've had a reasonable insurance plan, so I think we should use it," she added.

Any senior with a current drug plan should have already gotten a letter from their insurance, explaining if their current coverage is considered "credible," and thus avoiding this future penalty. If you have not received a letter yet, contact your current drug plan, said Lemke.

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