WASHINGTON – Dozens of private insurers began trying to sign up some 42 million older and disabled people on Saturday for the government’s new Medicare prescription drug benefit.
The program, which starts in January, is designed to reduce the out-of-pocket cost of medications. Overall, the government will spend an estimated $724 billion on the drug benefit over the coming decade.
Some questions and answers about the benefit:
Q How will the program work?
A People must enroll in a plan offered by a private provider that contracts with the federal government. The insurer will issue a card that beneficiaries can take to the pharmacy along with their doctor’s prescription. The pharmacist will use the card to determine the type of coverage the customer has; that dictates out-of-pocket costs.
Q What will it cost to participate?
A That depends on your health, income, where you live and other factors.
The standard benefit calls for premiums of about $32 a month and a deductible of $250. That means paying the first $250 worth of prescriptions for the year. After the deductible is covered, the customer pays 25 percent of the cost until drug spending reaches $2,250.
Beneficiaries then must pay all drug costs until they hit $5,100. At that point, the customer pays 5 percent of further charges.
Insurers know that beneficiaries have different needs and are offering different options. For example, some older people would prefer a more basic, no-frills plan. This allows providers to offer premiums dramatically below the $32 monthly national average. Several offer no deductible, meaning coverage starts with the first prescription purchase of the year. Many plans fill in portions of the coverage gap between $2,250 and $5,100.
Q How do I join a prescription drug plan?
A In the coming weeks, Medicare beneficiaries probably will receive numerous solicitations. Applications can be mailed back to a company or completed online. For help enrolling, the government has a toll-free number, 1-800-Medicare.
Q With as many as 70 options in some states, what tools are available to help determine which plan is best for me?
A You can research plans offered in your area by going to the Medicare Prescription Drug Plan Finder at www.Medicare.gov beginning Oct. 13. Representatives at Medicare’s 800 phone number can help, as can workers at a state health insurance assistance program. The phone number for each state’s program is in the Medicare and You 2006 handbook.
Q When can I enroll in a prescription drug plan?
A Between Nov. 15 and May 15. If you do not enroll when you first become eligible, you may have to pay a late-enrollment penalty. This penalty will be added to your premium each month for the entire time you are enrolled in Medicare Part D.
Q What if I already have prescription drug coverage through my employer or union?
A The government wanted to encourage employers and unions to continue offering coverage. Tax subsidies give an incentive to keeping that coverage and possibly using some of the savings to enhance drug coverage for retirees. People should check with their employer or union to determine what affect the new benefit will have.
Q I have a limited income. I don’t think I can afford the benefit. Is there extra help for me?
A Yes. Those with low incomes will get extra help to pay all or most monthly premiums and the annual deductible. In general, people who qualify for such aid must have limited assets and an annual income of about $14,355 for individuals or $19,245 for married couples. According to one study, people who take part in the low-income subsidy will pay 83 percent less for their drugs than they otherwise would without the benefit.
Q How do I apply for this extra help?
A Online at www.ssa.gov or www.socialsecurity.gov. By now, people should have received an application from the Social Security Administration, or one can be obtained from a local office. It should be mailed to the Social Security Administration, Wilkes-Barre Data Operations Center, P.O. Box 1020, Wilkes-Barre, PA 18767-9910.
Q I take three medicines – one for blood pressure, one for arthritis and one for cholesterol. Will my medicines be covered under the new benefit?
A Probably. But check to be sure. Each plan has a government-approved list of drugs that it covers. So far, it looks like the average plan covers about 88 percent of the 100 most commonly used drugs. Before enrolling, check with the plans you are considering to confirm that the specific drugs you take are covered. One other factor to keep in mind is the out-of-pocket cost, or co-payment, that comes when you fill each prescription.
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