Washington, DC - November 15, 2007 marked the opening of the enrollment period for the Medicare Part D prescription drug benefit, and it has become clear that the enrollment process is confusing and difficult for many seniors to navigate. Texas seniors in traditional Medicare have 56 prescription drug plans from which to choose. Additionally, Harris County seniors who participate in Medicare Advantage for their Part B coverage can choose among 33 Medicare Advantage plans.

The importance of this choice cannot be understated. Among the 56 stand-along prescription drug plans in Texas, premiums range between $12.10 and $97.50 per month, with annual deductibles ranging between $0 and $275. Each plan also covers a different list of drugs, making it essential that seniors evaluate the plans according to their own prescription needs. Medicare beneficiaries have until December 31, 2007 to choose a plan, so seniors should begin choosing the right plan. Once beneficiaries choose a plan, they must remain in that plan until the next open enrollment season – a year from now.

The best tools for evaluating prescription drug plans are found on www.medicare.gov or by calling 1-800-MEDICARE. Neither tool is user-friendly, with the phone number consistently busy and two-thirds of seniors never having used the Internet. This initial frustration is indicative of the many problems with this benefit that Democrats sought to fix when Congress developed the Medicare prescription drug benefit. However, a resource for reliable advice on this benefit is the local Area Agency on Aging of Harris County, which you can reach at 713-794-9001.

Without doubt, this benefit is far more complicated than other aspects of Medicare or Social Security. Unfortunately, this complexity was built into system from the beginning. Instead of modeling the prescription drug benefit on Medicare Part B – which provides seniors the simplicity of one insurance provider – Congress allowed private insurers to offer many plans. In theory, competition would encourage providers to lower their prices to attract seniors to their plans. In reality, however, seniors are confused about the scores of plans offered, and prices are much higher than what a single federal provider could have negotiated.

The unfortunate result is higher out-of-pocket drug costs for seniors. After seniors meet a $250 annual deductible, the Medicare prescription drug benefit provides a 75 percent subsidy for their drug costs up to $2,250. Once annual prescription drug costs reach $2,250, Part D beneficiaries fall into a coverage gap known as the donut hole and must pay 100 percent of all costs to $5,100. Drug costs above that level fall under “catastrophic coverage.”

However, there is extra help available for low-income Medicare beneficiaries. The Medicare Low Income Subsidy is often underutilized because eligible seniors don’t know about it, and the criteria are confusing and differ from program to program. The Low Income Subsidy provides extra help with prescription drug premiums, deductibles and co-payments under Part D, and is available to beneficiaries earning less than 150% of the federally-defined poverty level (FPL). Currently, that comes out to $1,276.25/month ($15,315/year) for an individual or $1,711.25/month ($20,535/year) for a couple. Specific benefits for this program are based on a sliding income scale and eligibility is subject to asset limitations. Please contact our office at 281-999-5879 or 713-330-0761 if you think you might be eligible. We can help you to benefit from any savings programs to which you are entitled.

As an added incentive to enrollment, Medicare administrators have announced that beneficiaries who qualify for the low-income subsidy can join a Medicare Part D prescription drug plan anytime throughout 2008, and are not limited to the open enrollment period. Enrollees will not be charged any late fees if they sign up before December 31, 2008.

Medicare should cover prescription drugs. They are an essential part of modern medicine. But we in Congress have a lot of work to do to fix the Medicare prescription drug law so that it works for seniors. Congress should eliminate the coverage gap – or donut hole – and allow Medicare to negotiate for lower prices similar to other federal agencies. Until then, we must help seniors in our community to navigate this system to find the Medicare prescription drug plan that best meets their needs.