Sign up to get email updates right in your inbox!

Home   /   news / News Item

Contact: TOM SCHNEIDER/ Artesia Daily Press

Seniors Get Medicare Update at Forum


Washington, Apr 9, 2004 - Area seniors curious about changes to Medicare under the Medicare Prescription Drug and Modernization Act of 2003 had an opportunity to present questions at a forum hosted in Artesia by Rep. Steve Pearce (R-N.M.).

On hand to answer questions was Jeff Flick, regional administrator for the Centers for Medicare and Medicaid Services.

The new law provides improved Medicare coverage by providing standard prescription drug benefits beginning in 2006.

The plan calls for a monthly premium of about $35, a deductible of $250 and coinsurance of 25 percent up to an initial coverage limit of $2,250.

Beyond $2,250, members will be responsible for 100 percent of drug costs until they reach a limit of $3,600.

“Once any senior spends 3600 out of their pocket, then the government steps back in and provides a 95 percent benefit the rest of the way through,” said Flick.

Beneficiaries with low savings and incomes below 135 percent of the federally-designated poverty line will pay no monthly premium, have no deductible and low co-pays for other prescription drugs. They will have no coverage limit.

Seniors who qualify will receive a $600 drug discount card in June of this year. A second card will be issued in January, 2005.

To qualify for the $600 credit, seniors must be enrolled with a Medicare-approved company and have Medicare Part A and/or Part B coverage.

Annual income must be no more than $12,569 if single or, if married, no more than $16,862 combined for both spouses, and they may not have Medicaid outpatient prescription drug coverage.

Joseph and Gertrude Hajek of Artesia asked if that $35 monthly premium will be in addition to the $66 they currently pay as members under Part B, and whether or not they will increase from year to year.

“The answer is, yes they will,” replied Flick. “In 2006 we are estimating that the premiums will be about $35 a month. That’s a total of a little over $400 a year.

“It’s important to keep in mind, however, that the average senior, we project, is going to be spending about $1600,” he said. “So when you pay $400 you’re getting $1600 worth of benefits.”

The premium, said Flick, will increase from year to year in proportion to the overall increase in drug costs.

Pearce also emphasized that the nature of the new plan is purely voluntary; seniors may choose not to participate.

“We have the option to take this or not to take it,” said Thelma Lewis of Artesia. “Most who won’t will fall into that gap, how will that be financed?”

“There is a possibility that some people who are going to fall into the gap might think twice, but the way the formula works, is that with the $250 deductible, you’re getting up to $2,250 in coverage,” said Flick.

“So initially you’re getting a very good deal. You’re getting much more than the $400 premium. So we think that most people are going to go ahead and opt into the program,” he said. “For most seniors this drug benefit is going to be a very good deal, even with that gap.”

Local physician Dr. Joe Salgado pointed out that for some individuals such as heart patients, the cost of just a few medications can easily exceed hundreds of dollars per month.

“What long-term plans are in place to counter rising drug costs in the future?” he asked.

“There’s some good news in this bill that we haven’t talked about,” Flick replied.

“One of the good things is the fact that for the first time ever Medicare is going to provide some help with what we call ‘disease management’,” he said. “Some people describe it as ‘chronic healthcare.

“So for those that have congestive heart failure or diabetes or other chronic healthcare diseases, there’s a new program to help you do a better job with working with those diseases,” he said.

Working with those diseases at an early stage, he said, will be instrumental in keeping down long-term costs.

“We believe some of these programs are going to be very helpful. That’s some of the best news in this bill,” said Flick.

“In terms of what’s going to happen in the future with drug prices, hopefully some of this chronic care management will help,” he said. “The way the formula works within the bill is that the maximum amount of $3,600 increases every year at the same rate that the cost of drugs is increased.”

Included in the bill are other mechanisms intended to help keep drug costs down.

“Most seniors today, when they need a drug they go into the drug store and buy it,” Flick said. “They’re not part of a big group.

“With this bill you’re going to be part of a big health plan that will be able to negotiate lower drug prices,” he said.

“One really important thing that I would encourage all of you to remember is 1-800-MEDICARE (1-800-633-4227),” said Flick. “Any questions that you have, you can call that telephone number any hour of the day or night.

“We staff it 24 hours a day seven days a week; the operators are very knowledgeable and can answer any questions you might have,” Flick said.

They can also be reached online at www.medicare.gov.

Print version of this document

Biography | District | News | Issues | Services | Photos | Kids Page | Contact | Home