Medicare Part D is Heartburn for Many Seniors

Medicare Part D began operating Jan. 1 but only a fraction of the 43 million eligible seniors have signed up for the new prescription-drug coverage.

Mr. Bennett, 82, is one of them. He knows he could probably save by signing up because of the high cost of his current Medigap plan but couldn’t determine the best option and exact savings because of all the choices – between 30 to 50 or more plans in some states!

The confusion begins here: the benefit is unlike any Medicare has offered since the program began in 1965. Rather than simply writing a check to providers of care or to the beneficiary, the program delivers benefits through insurance companies and pharmacy benefit managers. The beneficiary must buy coverage from either.

Another complication: the new plan may not cover all the medications seniors need. Doctors often begin patients on one medicine but switch to another if the drug doesn’t work. Medicare Part D might cover the original drug, but not the second. It also may  require patients to try cheaper medications before approving use of an alternative — even though patients may already have tried these drugs before Part D became law.

Seniors should keep a tally of how much they're paying for medications so they'll know when they've met the annual deductible or when they will encounter a gap in coverage under the plan, known as the "donut hole" (indicated by "No Coverage" in the chart above. Don't forget that certain expenses also don't count toward total out-of-pocket spending under Part D such as the cost of medications not covered by the plan or the costs of any medications imported from other countries.

This greatly complicates treatment for nursing home patients, the disabled, poor and recipients of donated drugs from drug companies.

“The one word that describes it is overwhelming,” said Ross Huntingford, president of PharmaCare Health Services, which dispenses drugs to nursing homes and other facilities.

Although not every Medicare recipient needs the new benefit, while others can save significantly. Part D expert Buffie Saavedra, a state aging and long-term care expert, helped one beneficiary enroll and reduce his monthly bill for five prescriptions from $280 to $41 — including the cost of a premium to secure the benefit and co-payments for the drugs purchased under the plan.

Delaying enrollment could penalize those who need to enroll later. The penalty does not apply if you are moving from an employer’s plan and provide a letter of Creditable Coverage Notice. Enrollment in Medicare D ends May 15, 2006.

If your employees need help with Medicare D, contact The Benefit Advocates at (336) 721-2029 or info@benefitadvocates.net.

Related Site:

• Medicare Part D Prescription Drug Coverage (Medicare)
• Medicare Prescription Drug Program (Senior Journal)

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