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HOMEPAGE > MEDICARE

Prescription Drug Cards are Now Available

Over 85,000 seniors in Southwest Michigan are now eligible for immediate savings through the Medicare Prescription Drug Card program. Find out which Prescription Drug Card is right for you at www.medicare.gov.

  1. Questions about selecting a drug plan?
    Visit www.medicare.gov

  2. Upton Medicare Fact Sheet
    View Need Help with Your Prescription Drug Costs?

  3. Find Out How Much You Can Save Under the New Program
    Visit www.gop.gov/medicare/gopdrugcalc.htm

  4. How to Outwit Medicare Drug Benefit Scams
    Visit www.aarp.org/bulletin/consumer/medicare_scams.html

  5. Extra Help is Available for Low Income Seniors
    View Medicare Fact Sheet - Department of Health & Human Services
    View Enrollment Letter and Important Questions and Answers about Your New Drug Coverage pdf file

 

March 26, 2006
NEW YORK TIMES

For Some Who Solve Puzzle, Medicare Drug Plan Pays Off
BY ROBERT PEAR

When Virginia G. Shores went to a pharmacy here to pick up five prescriptions, she thought she heard the pharmacist say she owed $250, but she was wrong. The cost, with her new Medicare prescription drug card, was just $50.

''I was flabbergasted,'' said Mrs. Shores, whose kitchen counter looks like a medicine chest, full of pills for high blood pressure, heart failure, arthritis, nerve pain and lung disease.

Mrs. Shores, 80, had been buying medicines from a mail-order pharmacy in Winnipeg, Manitoba, but now uses Medicare instead. ''I was amazed at the amount of money it saved,'' Mrs. Shores said. ''It was hard to believe.''

She is one of Medicare's satisfied customers. They are not vocal, they are not organized, but they say it was worth wading through the confusion and complexity of the new program to enroll.

Treasury Department figures show that Medicare spent a total of $5.1 billion on prescription drug benefits in January and February, the first months of the new program, which is expected to cost more than $675 billion over 10 years. Medicare officials say the program is paying for more than a million prescriptions a day.

One way to assess the program is to talk to people in a place like Tulsa. People here are far removed from the raucous debate in Washington, where Republicans describe the drug benefit as a boon to older Americans and many Democrats call it a disaster.

The experience of those who have enrolled is particularly significant because millions of Medicare beneficiaries face a May 15 deadline for signing up. Current beneficiaries who decide to join after that date will generally have to wait until Nov. 15 and will then pay higher premiums as a penalty for late enrollment.

In Oklahoma, Medicare beneficiaries can choose from 43 prescription drug plans, with premiums ranging from $10.07 to $70.79 a month, different co-payments and very different lists of covered drugs.

Satisfied beneficiaries say they could never have analyzed the options or made a choice without the help of friends and relatives, pharmacists or counselors from groups like LIFE Senior Services, a private nonprofit group, which offers advice at seminars and enrollment clinics in the Tulsa area.

The counselors are adept at using the Medicare Web site to compare drug plans and identify the ones with the lowest overall annual cost for a particular beneficiary. Before selecting a plan, a beneficiary typically must spend an hour with a counselor, but some spend much more time.

For example, Bobby G. Brown, a retired letter carrier, and his wife, Anna, both 71, spent four hours with a LIFE counselor. ''It was well worth the time,'' said Mrs. Brown, who is being treated for congestive heart failure, rheumatoid arthritis, lupus, high cholesterol, depression and other ailments.

He takes 6 drugs; she takes 18. They enrolled in different plans -- WellCare's Signature plan and the basic plan offered by Blue Cross and Blue Shield of Oklahoma -- and their combined drug costs will plunge to $4,900 or less a year, from more than $25,000.

Mrs. Brown, 71, had been relying on free samples from doctors for some expensive medications, but she found it demeaning to ask for them. ''You get the feeling you're a beggar,'' she said.

The satisfaction of some beneficiaries stands in contrast to the frustration of many others, who were overcharged or unable to get essential medicines in the first chaotic weeks of the program.

''People who are satisfied are the quieter voices,'' said Leslie A. Dick, executive director of the Burgundy Place retirement community in Tulsa.

Many beneficiaries say they are grateful to local insurance counselors, rather than to Medicare, the government or politicians.

''We had a whole lot better deal before the government started messing with it,'' said Francis A. Murphy, 79, a retired airline mechanic who is losing drug benefits from a former employer. He said he did not expect to see any savings under Medicare. Beneficiaries are anxious about their choices for good reason. Their out-of-pocket costs under different plans can vary by hundreds or thousands of dollars a year.

Jack L. Coffey, associate dean of the University of Oklahoma College of Pharmacy, owns four drugstores. ''In a majority of cases, I have seen some reduction in costs to the patient,'' Mr. Coffey said. ''But for some people, their medications will cost them more.''

People may pay more if they already had good coverage, from Medicaid or private insurance, or if they select a Medicare drug plan that does not cover the drugs they need.

Even those who save money may complain because the new program is ''much too complicated for a lot of people to understand,'' Mr. Coffey said.

Todd E. Pendergraft, owner of a Medicine Shoppe pharmacy in Broken Arrow, Okla., outside Tulsa, said the new drug coverage was ''significantly beneficial'' to one-third of his 750 Medicare patients, ''marginally beneficial'' to half the patients and ''no benefit at all'' to the remainder.

People satisfied with the new drug benefit appear to share these characteristics:

They did not sign up for one plan and then switch to another.

They did not rely on advertising or their own instincts, but got help from Medicare experts, insurance counselors or computer-savvy friends and relatives, who used the automated ''plan finder'' at the medicare.gov Web site.

They are not on Medicaid, the federal-state program for the poor. People eligible for both Medicaid and Medicare had comprehensive drug coverage under Medicaid, but lost it on Jan. 1 and were assigned at random to private Medicare drug plans. The Medicare plans may charge slightly higher co-payments and often cover fewer drugs.

In addition, Medicare beneficiaries are more likely to appreciate the new benefit if they live in places like Oklahoma that did not have generous state-financed programs to help them with their drug costs. Drug benefits have been available for years to low-income people through state programs in Maine, New Jersey, New York and Pennsylvania, among other states.

Dr. M. Jean Root, a geriatrician in Tulsa with several hundred Medicare patients, said: ''About half of my patients say they like the new benefit and are saving money. The people most likely to benefit have enough education and perseverance to navigate the system, which is extremely convoluted and complex. Or they have friends and relatives to help them.''

But Dr. Root said, ''The other half of my patients, including those with dementia and terminal illnesses, don't have the energy, the interest or the mental capacity to work through the system.''

Counselors are reaching a small fraction of all beneficiaries. Carol H. Carter, a spokeswoman for LIFE Senior Services, said: ''Many beneficiaries are terrified of making the wrong decision and overwhelmed by having so many choices. The only reliable way to compare plans is on the Medicare Web site, and that in itself is scary to some seniors.''

Beneficiaries could face new problems in coming months. Insurers can impose stricter limits on access to certain drugs after March 31, when a 90-day transition period ends. In addition, some beneficiaries will have to pay more at the pharmacy counter, because most drug plans have a gap in coverage after a person's total drug costs reach $2,250. The gap lasts until the beneficiary incurs total drug costs of $5,100. Beyond that point, Medicare pays about 95 percent of the cost of each prescription.

Still, counselors say, many beneficiaries will come out ahead if they enroll.

Those who have signed up say the total cost of all their drugs under Medicare is often less than the amount they were paying for just one prescription in the past.

Mary N. Hooser, 89, of Sapulpa, Okla., takes eight medications for heart disease, ulcers, depression and early signs of Alzheimer's disease. Her children had been chipping in to cover the cost, $476 a month, including $155 for the Alzheimer's drug. Under Medicare, the cost for all her drugs is less than $100 a month.

''This is a tremendous help to my mother and me,'' said Mrs. Hooser's 73-year-old daughter, Mary L. Ward.

Charlene G. Bandurski, who had polio as a young child, was not enthusiastic about the prospect of signing up for the Medicare drug benefit. Indeed, she said: ''I looked forward to it with dread. We had heard that it was a mess, and so confusing.''

But since signing up in December, Ms. Bandurski said, she has been pleasantly surprised. ''For a medicine that cost $120, we now pay $20,'' she said. ''At first, you don't believe it. It's almost like it's too good to be true.''


 

October 11, 2005
New York Times

As Deadline Nears, Sorting Out the Medicare Drug Plan
By ROBERT PEAR

WASHINGTON, Oct. 10 - In the next few weeks, millions of Medicare beneficiaries will make decisions that could affect their out-of-pocket medical costs for years to come.

They have to decide whether to sign up for a prescription drug plan, sorting through dozens of options with radically different costs and benefits.

Information issued by the government, while generally accurate, tends to give an upbeat assessment of the new benefit, emphasizing the advantages. But the new program is so complex that the government, by its own account, has made two significant errors in explaining it to the public.

Federal health officials incorrectly described the standard minimum drug benefit in an advertisement that appeared on Sept. 25 in Parade magazine, the Sunday newspaper supplement with a circulation of more than 37 million. In addition, the official Medicare handbook, sent to all beneficiaries, significantly overstates the number of prescription drug plans that will be available without any premiums for low-income people.

The Bush administration has notified Congress of the errors and says they will be corrected in future brochures and on the Medicare Web site.

Drug plans began marketing activities, including unsolicited telephone calls to beneficiaries, on Oct. 1. People can sign up on Nov. 15. Coverage begins Jan. 1. And May 15 is the last day to sign up in 2006.

A person who spends $2,000 a year on prescription drugs could save $928 next year under a drug plan offering the standard benefit with average premiums. A Medicare beneficiary who spends $4,850 on medicines would save $1,116. But people with only $530 in drug costs would pay one-third more than they do now.

Here are questions and answers about the program, gleaned from the 2003 Medicare law, federal regulations and interviews with health officials and Medicare experts who counsel beneficiaries.

QUESTION To whom is the drug benefit available?

ANSWER Everyone on Medicare. It should be particularly useful to people with low incomes or high drug expenses. But the government says that all beneficiaries should consider signing up because most will eventually need prescription drugs, and if they delay enrolling, they will generally be subject to financial penalties.

Q. Do beneficiaries have to do anything to get the new coverage?

A. Yes. In general, people will not automatically receive the drug benefit. They need to sign up for a specific plan, offered not by the government but by a private insurance company, which is subsidized and regulated by the government.

Q. Can people put off a decision until they really need help with their drug costs?

A. Yes. But they face higher premiums, with a 1 percent surcharge for each month of delay. If a person delayed enrollment for two years, the premium could be permanently increased by 24 percent.

Q. How much will the new drug coverage cost?

A. Premiums, co-payments and other costs vary from one insurance plan to another. Premiums will average $32 a month, but range from less than $2 to more than $100. Every state but Alaska will have at least one plan with a premium less than $20 a month.

Q. Should people sign up even if they spend very little on drugs?

A. It might be worthwhile to do so, experts say. Even if healthy beneficiaries do not immediately save money, they can obtain protection against unexpected or catastrophic costs, just as people do when they insure their homes against fire and storm damage.

Q. How does a person decide which drug plans are best?

A. This will not be easy. In almost every state, more than 40 free-standing prescription drug plans will be available. One plan may cover 1,300 drugs, while another covers 2,500. The first plan may have lower premiums. But total out-of-pocket costs may be lower under the second plan.

Under many plans, the beneficiary will have to pay 20 percent of the cost of each prescription. Under other plans, the beneficiary will have to pay $5 for a generic drug, $25 for a preferred brand-name drug and $45 for other brand-name medicines.

Over all, the government says, the new benefit will pay about half of drug costs for a typical person with Medicare next year. But savings will vary widely, depending on a person's circumstances.

Q. If a Medicare beneficiary signs up for a particular drug plan in 2006, will it be available in later years?

A. Not necessarily. The company can pull out of Medicare in 2007. With federal approval, it can raise premiums, cover different drugs or fundamentally change the structure of the benefit. Beneficiaries can then shop for other plans.

Q. Many retirees already have drug coverage from former employers. How does the new Medicare drug benefit work for them?

A. In many cases, retirees will want to keep their current coverage because it is more generous than Medicare's standard drug benefit. Many employers have said they intend to maintain drug coverage for retirees next year, with the help of federal subsidies.

By Nov. 15, every employer who provides drug coverage to retirees is supposed to send them notices stating whether the coverage is at least as good as the standard Medicare benefit. Employers are supposed to send the same type of notice to active workers eligible for Medicare. Retirees who do not receive such notices should check with their former employers.

At some companies, retirees may lose all employer-sponsored health benefits, including coverage for doctors' services and hospital care, if they enroll in a Medicare drug plan. Other employers will supplement the Medicare drug benefit or help pay the premiums.

Q. Neighborhood drugstores are giving out information on the new benefit. Can people enroll there?

A. In some cases, yes. Many drugstores will allow licensed insurance agents to enroll people on the spot. For example, CVS says it will allow sales representatives from Aetna, Humana and UnitedHealth Group to sign up Medicare beneficiaries in its stores. Humana says it will have sales representatives in more than 3,200 Wal-Mart stores around the country.

Pharmacies can distribute marketing materials, including enrollment application forms, for Medicare drug plans. But they are forbidden to steer people to a particular plan.

Q. Many people have private insurance that supplements Medicare. Some of these Medigap policies cover prescription drugs. Can people keep that coverage?

A. Yes. But in many cases, people will save money and get better coverage if they sign up for the new Medicare drug benefit. People cannot have drug benefits from a Medigap policy and a Medicare drug plan at the same time.

If people keep a Medigap drug policy that is less generous than the standard Medicare drug benefit, they may face a late enrollment penalty if they decide to sign up for Medicare drug coverage in the future. Those who sign up for a Medicare drug plan next year can buy a separate Medigap policy to help pay for doctors and hospitals, but not drugs.

In many parts of the country, Medicare beneficiaries have other options. They can get all Medicare benefits, including prescription drugs, from a health maintenance organization or a preferred provider organization. In some plans, like H.M.O.'s, beneficiaries may save money, but face restrictions on their choice of doctors and hospitals.

Q. What about people who cannot afford drug coverage under Medicare?

A. One-third of all Medicare beneficiaries may be able to qualify for extra financial help. The assistance will be available to an individual with annual income less than $14,355 and assets less than $11,500. The same type of aid will be available to couples with incomes less than $19,245 and assets less than $23,000. Assets include savings, investments and real estate other than a home.

The extra assistance, worth an average of more than $2,000 a year, will reduce premiums, deductibles and co-payments for those who qualify.

   
Congressman Fred Upton Michigan Sixth District