By Michael Mager/Features Editor
November 20, 2006 05:54 pm
—
For anyone interested in learning how to navigate through the maze of the Medicare Part D puzzle, here’s a quick solution: Go to the Medicare.gov Web site online and glance through the online publication the federal government has placed there — all 156 pages of it.
Since its inception last year, the government’s medication assistance program for seniors has taken a lot of flack for being hard to understand. The length of the governmental guide to the program is a case in point. Seniors who were registering for the program for the first time last year had six months in which to decipher the program. This year, that window of opportunity is six weeks, not six months. And those who wait until just before the window closes will be out of luck as far as assistance for their drug benefits in January.
“People have been coming in all year,” said Barry Sarchet, a pharmacist at Walgreens in Cleburne. “They’re all confused. After all, there are only about 500 different plans for them to choose from. We help them out by feeding information about the medications they are taking into the computer so they can compare different programs that cover the ones they’re taking. That makes it easier for them to choose the one that’s right for them.”
Walgreens sponsors one of the 500 programs Sarchet mentioned. Like most other providers, brochures about their program and about Part D in general are readily available. When asked for information about the program at the Cleburne branch of Social Security, though — one of the biggest federal offices in the area — there were no government brochures available at all about the program.
“The whole thing is very confusing,” retiree Claudine Buford said. “There are so many plans to choose from, and there’s no way to look through them all, and it’s nearly impossible to compare them. Each one has different medications that are covered and different prices as well as different deductibles. It’s horrendous. When I tried to find out what to do from the government, it actually took me two months just to get through to them. I guess I wasn’t the only one who was confused. Finally, I just chose the one offered by AARP.”
Conor Lee, an educator for the Center for Medicare and Medicaid Services, cautions seniors to be sure to choose some plan by Dec. 31.
“If seniors do not choose a plan by Dec. 31, 2006, they are at risk of losing Medicare Part D prescription drug coverage for all of 2007 or risk being re-enrolled in a plan that does not cover medically necessary drugs. Beneficiaries could begin enrolling in Medicare plans beginning Nov. 15.
CMMS is urging Medicare beneficiaries to sign up for a plan by Dec. 8 to ensure they begin receiving drug coverage on Jan. 1 and avoid missing critical drug dosages.
CMMS offers these ten tips for seniors:
F Calculate your health care costs. Try to figure out how much you paid for medications, hospital bills, doctor visits and other health costs this year.
F Write it down. Make a list of your doctors and drugs as you consider your options.
F Confirm your coverage. Make sure your doctors and drugs are covered by the plans you are considering.
F Do your homework. Consider an insurance company’s financial security, customer service and reputation before signing up.
F Consider different options. New Medicare insurance plans often include health and drug insurance for little or no premium beyond Medicare.
F Be realistic. Don’t leave a Medigap or supplemental insurance plan for a $0 premium plan if you expect to be frequently hospitalized.
F Be a smart shopper. Compare plans from a variety of companies or use a service that can help make that comparison for you.
F Don’t believe everything you hear. Be cautious about signing up for a plan at a seminar that sells only one company’s plans.
F Read the fine print. Always review potential plans’ “Summary of Benefits.”
F Get expert advice. Use appropriate independent resources to help you assess how competing insurance plans may or may not meet your needs.
Josh Taylor, an assistant to U.S. Rep. Chet Edwards, D-Waco, indicated that revision and simplification of the program is high on the agenda of the new, Democratic majority congress. Edwards, Taylor said, tried unsuccessfully in the last session of Congress to address the possibility that Medicare use the same negotiating tactics used with high praise by the VA.
“It is outrageous that higher drug prices will be forced on many seniors because pharmaceutical lobbyists passed special interest language that prohibits Medicare from negotiating lower drug prices,” Edwards said. “The Veterans Administration is allowed to bargain for cheaper drugs on behalf of our veterans. Why is Medicare being prevented from bargaining to reduce prescription drug prices for America’s seniors?”
In a letter to his constituents, Edwards said, “A report released by the House Government Reform Committee comparing the prices seniors in America pay for the five most prescribed drugs to other industrialized countries reveals that American seniors pay considerably more. The average cost for Prilosec, Plavix, Zocor, Prevacid and Celebrex, the five most common prescribed drugs, show that U.S. drug prices are 174-percent higher than the United Kingdom, 152-percent higher than Canada and 142-percent higher than France.”
Wal-Mart has recently thrown a new dynamic into the mix. By introducing a $4 across-the-board pricing for many of its generic drugs, the retail chain is making a bid to get a big chunk of the pharmaceuticals market. However, the true back-breaker for many senior citizens is not the time-tested drugs that are in generic form, but the newer, more exotic medications that can run into the hundreds of dollars for a month’s supply.
For now, seniors will have to find ways to negotiate the perilous and perplexing maze that is the Part D program of 2006. With enrollment time open only a short while, the best advice seems to be to get as much advice as possible and to make a decision soon.
Michael Mager can be reached at 817-645-2441, ext. 2338, or features@trcle.com.
Copyright © 1999-2008 cnhi, inc.