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Medicare D Outlined to Seniors
By Julie Wernau
Waterford -- "Everybody's looking for the silver lining. There is none," Waterford resident Virginia Daniels said.
Waterford seniors like Daniels packed the community center's cafeteria recently for a seminar titled "Medicare Part D: What it means to you."
Medicare's new prescription drug cards are scheduled to arrive this October but so far, Medicare and Medicaid Service have revealed few details about the cards. Information such as how many cards there will be, what medications will be covered and how much individual insurance companies will charge for those medications is still under wraps.
"We haven't even seen a draft of the Medicare and You 2006 Handbook," said Diego Gleyzer, an outreach worker at Senior Resources Agency on Aging in Norwich, which has been traveling around Connecticut to conduct the seminars.
According to Gleyzer, once the new cards come out, most seniors will be required to sign up for the plan or face penalty fees or loss of coverage.
Starting Jan. 1, Medicaid will no longer pay for prescription drugs eligible for Part D, although it may pay for other drugs. At the same time, Medigap will stop selling prescription drug coverage. Same goes for the government's drug assistance program, which issues discount drug cards.
The new prescription drug cards for Medicare D, which are estimated to cost about $37 per month, will carry a $250 deductible. After the deductible is reached, Medicare will pay 75 percent of drug costs, but once those costs exceed $2,250, seniors will have a gap in coverage.
According to Gleyzer, Medicare will not pay another cent until seniors have spent $2,850 out of their own pockets. After that, the coverage is 95 percent.
In Connecticut, ConnPace, which is run through the Social Security Administration, will "wrap-around" Part D, meaning that it will cover the premiums for Part D and ensure that prescription drug costs do not exceed $16.25 per prescription; however, only those with lower incomes are eligible. Mitzi Wohllenben, from the Social Security Administration in New London, said the SSA tried to pinpoint as many residents who may be eligible for extra help as possible and sent out forms about two weeks ago to those individuals.
"There's a big hole in the middle where you're not going to be covered," she told seniors.
However, other seniors may be eligible and even those already enrolled in ConnPace will have to fill out yet another form in order to receive the extra help.
If this sounds complicated already, the confusion hasn't even begun.
Seniors who already have prescription drug coverage under their insurance company will receive a letter in the mail by Nov. 15, telling them whether or not their coverage is "as good or better than" Medicare D, Gleyzer said.
If it isn't as good as Medicare, seniors will be required to sign up for Medicare D instead if they wish to be covered for prescription drugs. If their insurance is as good as Medicare, their insurance company will continue to cover their prescription drugs.
Other seniors, like those already on Medicare, SSI, QMB, SLMB or ALMB/QI, will be automatically enrolled in Medicare D.
Many seniors at the seminar wondered about the nature of the prescription drug cards themselves, which will each list covered medications on a "formulary list."
"If you don't see a drug you take on the list," Gleyzer said, "there are ways to put that drug on the list through an appeals process. ...Folks can't live without their prescription drugs for one or two weeks; so, it's going to have to be a very quick appeals process."
The confusion, seniors said, comes from the fact that some drugs they take may be on one card, while others may show up on another card.
Also, not every pharmacy covers every card, and seniors will have to choose one pharmacy at which to purchase their medications, and call that pharmacy themselves to find out what is and isn't covered. Also, even those drugs that are covered on more than one card, may cost different amounts depending on which card the seniors choose and the prices can change at any time.
"You have to realize these plans are being run by insurance companies," said state Rep. Betsy Ritter, D-Waterford, who showed up to hear the talk.
All this, said seniors, requires far more research than they can easily handle, considering many seniors' limited access to transportation and limited knowledge of the Internet.
"It's too nebulous. You can't understand anything," said Al Lewis, a senior from Waterford. "They keep saying, 'It's coming; it's coming.' It isn't here."
Ritter said the Connecticut legislature did all they could to help seniors by ensuring that ConnPace wrapped around Medicare, but that the program was really the baby of the federal government. She expects trouble once pharmacies, doctors' offices and government agencies become flooded with phone calls this fall.
Lewis was frustrated that gap coverage was only available to those with lower incomes.
"If you worked all your life and take care of yourself, you're not eligible for any help. ...I never drew an unemployment check in my life."
Mary LeBlanc of Waterford said her husband worked for Pfizer and she will be waiting to see what the letter from United Healthcare tells her about her coverage. She found the new plan very confusing.
"How can you get all that?" she asked.
Ted and Helen Shaw of Waterford, married 60 years next February, wondered what the plan would mean for couples. Helen Shaw's drug costs exceed $5,000 per year, but Ted Shaw has very few prescriptions.
"I think you're going to have other confusion from all of us," Ted Shaw said. "Many of us, we've been going to the same pharmacy for 30 years. I'm disappointed that we couldn't have had an absolute simple plan rather than this confusing thing."
Source: Shores Publishing
Senior Citizen Aticles | Medicare D
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