Making Medicare Meaningful to Ohio’s Seniors
   By Congresswoman Deborah Pryce  

By now, you probably have heard about the historic healthcare legislation that Congress passed and President Bush signed into law that will give seniors access to prescription drug coverage, through the Medicare program, for the first time in American history.  As a result of such sweeping improvements, many mixed messages have been swirling around town and in the media.  Seniors and their families deserve to know the facts – how this new law will affect them personally if they choose to take advantage of the new opportunities it has to offer.

Last week, I visited two Columbus-area retirement communities, accompanied by health care experts from Ohio, and the Bush Administration, to provide some answers as to how this plan will work. 

First and foremost, it is important to explain that the new Medicare Prescription Drug benefit is entirely voluntary.  If a senior likes the traditional Medicare plan they’re currently enrolled in own, they can remain on that plan with absolutely no changes.  But, for those who do wish to participate, they will see immediate savings through a prescription drug discount card – a swipe card – that they can use at their local pharmacies.  And, when the law is fully implemented in 2006, seniors will have access to a comprehensive plan that offers coverage of their drug costs. 

Medicare is a complex program, and the seniors I met with asked several important questions about how this plan will work for them.  Among the most frequently asked questions were….

1)  How does the prescription drug discount card work?  What is the cost?  Is it good for both years or do I have to renew it? 

Recently, the Department of Health and Human Services (HHS) announced the approval of 28 private sponsors to provide seniors with savings on their prescription drugs through a drug discount card.  In April, seniors can shop around to compare prices of medicines offered by the drug card sponsors - either by calling 1-800-MEDICARE or visiting www.medicare.gov - to find out which card is best for them.  Once they decide on a card, they can begin signing up on May 1, and can begin to see savings on their prescription drugs beginning on June 1, 2004. 

Essentially, the card will look like a credit card - a swipe card - that you can take to your pharmacy to receive an immediate discount as you purchase your medicines.  The new card will provide up to 25% in upfront savings, which for the average senior amounts to about $300 in savings a year.  The card will also provide a $600 annual credit to eligible low-income Medicare beneficiaries whose income is less than $12,569 each year or married couples whose income is less than $16,862. 

The drug card will cost no more than $30 per year.  However, some cards may charge a lower enrollment fee or none at all.  The card will remain valid until you specify otherwise.  The card can be used until 2006 when the comprehensive benefit begins.

In the next month, HHS will mail a short publication to every Medicare household explaining the card, and the Social Security Administration will mail a separate letter to Medicare beneficiaries with lower incomes, who are likely to be eligible for the $600 credit.

2)      Can you provide me with an example of how this discount card will work?

A senior needs to fill a prescription for Lipitor, a cholesterol lowering drug that can prevent heart failure.  In 2002, an estimated retail price for 30 tablets of Lipitor (20 mg) was $108.65.  For beneficiaries, this new card could mean a savings of nearly $22 a month off the retail price, and eligible low-income seniors could receive additional assistance.  This example is based off a drug card sponsor offering a discount of 20% off the retail price.

3)      How will the new prescription drug benefit that begins in 2006 work? 

Medicare beneficiaries will be able to enroll in the comprehensive prescription drug benefit beginning in 2006.  For a premium of $35 a month, and after meeting a $250 deductible, Medicare will cover 75% of a seniors drug costs up to $2,250.  Once a senior’s out-of-pocket drug costs reach $3,600, Medicare will cover 95%.  More than 438,000 of Ohio's neediest seniors will pay minimally for their medicines - at most $2 for generics and $5 for name-brand prescription drugs.

4)  What is the government doing to encourage companies to continue providing benefits to retirees? 

Unfortunately, due to rising health care costs, more employers have been dropping health coverage offered to retirees.  If the current trend continues, the responsibility of providing health care will increasingly fall on the shoulders of the government, making it more expensive for taxpayers.

Employers want to keep offering health care coverage to their former employees, but need help.  Under the new Medicare law, employers will be given financial incentives to continue providing retirees their existing health care.  In addition, employers will be allowed to fold into their retiree coverage the new features of Medicare – to encourage employers to continue offering retiree health insurance.    

These are just a few of the most commonly asked questions. I look forward to holding another community workshop on Medicare soon.  But, in the meantime, please visit Medicare’s website at www.medicare.gov or call 1-800-MEDICARE if you need more information on the choices available to seniors.  Of course, my office also stands ready to help you with this new law and can be reached at 614/469-5614.    

This new Medicare plan, arriving in June, holds much promise for an improved quality of life for our senior citizens.  It’s about time that America’s seniors got some real information on the improved Medicare plan so they can make decisions that will help them live longer, healthier lives.