Home |  Elder Rights |  Health |  Pension Watch |  Rural Aging |  Armed Conflict |  Aging Watch at the UN  

  SEARCH SUBSCRIBE  
 

Mission  |  Contact Us  |  Internships  |    

        

 

 

 

 

 

 

 

 

 

 

Medicare Drug Plan Bitter Pill for Some


By Suzanne Travers, Herald News


November 7, 2007

For seniors, evaluating Medicare prescription drug plans is turning out to be an annual chore about as distressing as filing income tax returns.
"I'm going to have to do this every year?" one senior questioned Sheila Brogan, an eldercare coordinator at the Northwest Senior Center in Midland Park who has been counseling seniors on which drug plan will cover the medications they take at the best price.

Yes, Brogan told her.

But many options exist for seniors to make selecting a plan for the coming year easier.

Some local senior centers are offering information sessions to acquaint seniors and caregivers to the two-year-old federal prescription program, known as Medicare Part D.

The Passaic County Senior Services office has state health insurance assistance program (SHIP) counselors to assist individuals choose a plan. The federal Centers for Medicare and Medicaid Services offers help through its 24-hour toll-free hotline and a "plan finder" on its Web site that enables users to compare plans.

Seniors may change plans during the open enrollment period, which begins on Nov. 15 and concludes on Dec. 31.

Two years into the program, said Mary Kuzinski, director of Passaic County Senior Services, most seniors and caregivers are familiar with the basic concept and philosophy of Part D, which promises lower medication costs for seniors and the disabled by offering prescription coverage through private insurance plans that are subsidized by the federal Medicare program. Since many private insurers have raised plan premiums or changed the list of prescriptions covered, each senior is faced with the choice of remaining with their current plan or selecting a new one.

New Jersey seniors must choose from 57 plans this year, up from 44 in 2006.
"With so many plans, the generic presentation just doesn't work anymore," Kuzinski said. "We're encouraging people to contact the office if they need one-on-one counseling."

Brogan, who conducted an information session for about 50 seniors at the Northwest Senior Center on Monday, recommends that seniors who switch plans do so well before the Dec. 31 deadline, so their paperwork is processed by the time they need to refill prescriptions in early January.

She noted several changes to drug plans this year: deductibles have risen for many plans from $250 in 2006 to $275 in 2008. Previously, several plans charged high monthly premiums in exchange for covering brand-name and generic drugs through the "doughnut hole" coverage gap, when seniors whose annual prescription costs have reached $2,510 must pay the entire medication cost until their spending reaches $5,726.25. This year, Brogan said, most plans offering gap coverage will only cover generic drugs. Be aware, she cautions, that some plans also offer cheaper coverage for people who order their prescriptions by mail.

All seniors are encouraged to review their respective prescription coverage, said Allison Henry, a spokeswoman for the Centers for Medicare and Medicaid Services. And Kuzinski echoes the advice saying seniors should read any correspondence they receive from their current coverage plan or from Medicare, including the "Medicare and You" 2008 handbook.

Several groups of seniors do not need to scrutinize their plans. Those with coverage from an employer, union, or retiree plan approved by Medicare as "creditable" do not need to enroll in Part D plans.

New Jersey low-income seniors enrolled in PAAD, the state's Pharmaceutical Assistance for the Aged and Disabled, will be automatically enrolled in a plan that covers their medications.

Most dual eligibles, people on Medicare and Medicaid, will be automatically enrolled. Seniors with Medicare Advantage Plans, which include prescription drug coverage, may ignore Part D.

Meanwhile, advocates continue to urge seniors without prescription drug coverage to enroll in a minimal plan to avoid future penalties for later enrollment.

Although the majority of seniors enrolled in Part D plans pay less for prescriptions than if they had to pay for medications out-of-pocket, several seniors interviewed at the Midland Park information session expressed frustration with the benefit.

One Bergen County woman, who declined to be named because she feared retaliation by her company that administers her plan, said she had to fight to have prescriptions covered and is currently suffering through the coverage gap.
"This is such a rip-off," she said. "The prescription drug and insurance companies are trying to control doctors as to what they prescribe for you. You feel manipulated, used, and abused."

Tony Trusso, 71, of Midland Park, said, "All these options are really overwhelming," Trusso said. "They should make it like Medicare – simple."


More Information on US Health Issues


Copyright © Global Action on Aging
Terms of Use  |  Privacy Policy  |  Contact Us