Puzzling out Medicare Part D

Article excerpt


Prepare for confusion, puzzlement, uncertainty, head-scratching. That's the best way to get in the mood for handling the new Medicare Part D drug benefit for yourself, a client, your parents or anyone else among the 40 million people enrolled in Medicare.

Lots of advice will be available from lots of people, but it will still be an intricate exercise for most individuals. At least there's no rush: The benefit begins January 1, but enrollment stays open for 2006 coverage until May 15.

Remember that the new prescription drug coverage is voluntary-people have to sign up. However, there will be a financial penalty for delay: For every month beyond the May 15 deadline, the monthly premium will increase by 1%. If the premium were $30 a month, for example, and someone waited three years to enroll, the resulting premium would be $40.80 a month (an increase of 36%).

The best deal is for low-income people who have no drug coverage now. Individuals with incomes below $14,355 and couples with incomes under $19,245 in 2005 would get their coverage as a minimal-cost bargain, with extra financial help to pay the monthly premiums, deductibles and co-payments. But remember, there is an asset test. Social security sent out nearly 20 million notices and application forms, but only 3 million were returned. Lots of people can get help, but many don't realize they are eligible.

Those having coverage as a retired military person or one of their dependents can stand pat with these top-quality policies: Veterans Administration or TRI-CARE coverage, where prescription drugs are a bargain. The new Medicare Part D likely won't improve on these plans.

Elders with Medi-Gap coverage might be able to save some money, especially if they hold the more expensive policies known as H, I or J, which help pay for drugs. The new Medicare benefit will generally be cheaper, so beneficiaries can drop the drug part of Medi-Gap and should be able to save some money on the reduced policy.


People with disabilities or who have a chronic illness requiring lots of medications need to make sure they get a look at the formulary-the list of approved drugs for each plan they are considering-before signing up. They should get the list of drugs with prices and of the participating pharmacies that will fill a plan's prescriptions, as well as do a detailed comparison with their current coverage. Each plan will have a different formulary, said James Radack, spokesperson for the National Mental Health Association. "They need to look through all the plans; there have been some antianxiety medications that plans do not have to cover," he said. The organization has its own Medicare Part D workbook available by phoning (800) 969-6642 or on its website at www.nmha.org.

People in an HMO that already offers drug coverage probably won't have to do anything. Expect HMOs to upgrade their coverage to make sure they offer what the Medicare Plan D provides, because HMOs won't want to lose Medicare customers. …