South Coast Seniors Prepare for Changes in Medicare
WASHINGTON, Nov. 10-More than 130 people crowded into Brooklawn Park in New Bedford last Friday to attend an information session about the new Medicare prescription drug benefit. So many people showed up, according to one of the organizers, that they ran out of chairs.
The attendees asked questions throughout the presentation, and afterwards approached Andrea Mendousa Priest, regional director of Serving the Health Information Needs of Elders (SHINE), with more concerns.
“People just want to make sure they understand what to do next,” Priest said. “They’re hearing a lot about it, but they’re feeling in limbo.”
Enrollment for Medicare’s new prescription drug coverage begins on Tuesday, with benefits available beginning Jan. 1. The implementation of the program represents a milestone for Medicare, the federal health insurance program for the elderly and people with certain disabilities.
“The key thing is that for the first time, everyone who is on Medicare will have prescription drug coverage,” said Dr. Charlotte Yeh, administrator of the Boston regional office of the federal Centers for Medicare and Medicaid Services.
Medicare has traditionally covered hospital stays and routine medical care. However, only beneficiaries who purchased private supplemental insurance policies (so-called medigap insurance) or those enrolled in Medicare Advantage Plans-a managed care option akin to an HMO-received any prescription coverage.
The Medicare Modernization Act, signed into law in 2003, created a system for supplying this missing benefit. Private insurance companies will provide a selection of prescription drug plans that meet federal requirements for coverage and affordability.
Those currently enrolled in basic Medicare will have the option of selecting one of these plans or switching to an Advantage Plan that includes prescription coverage.
People who already have separate prescription coverage-from a union, a retirement plan, or one of the costlier medigap policies-will receive letters analyzing whether Medicare or their existing plan would provide better coverage.
Seniors who now receive their medications through Medicaid, the federal-state program for low-income people, will receive their prescription coverage under Medicare as of Jan. 1. They must choose a plan before that date or they will be automatically enrolled in a randomly selected plan.
Standard coverage will pay 75 percent of drug costs, after a $250 deductible, up to $2,250 in total drug spending. To protect against catastrophic expenditures, all of the prescription plans will pay 95 percent of all costs after a beneficiary’s annual out-of-pocket drug expenses have reached $3,600.
Some plans will fill part of the coverage gap in exchange for a higher premium. And all plans call for co-payments by beneficiaries that vary according to the cost of the drug.
Monthly premiums for the 44 plans that will be available in Massachusetts range from $7.32 to $65, and some offer a reduced or no-cost deductible. The premiums are in addition to the premiums Medicare beneficiaries already pay for medical coverage.
Many low-income seniors will qualify for additional assistance that will reduce or eliminate premiums, deductibles and drug co-payments. In Massachusetts, people who are currently beneficiaries of the Prescription Advantage program may also receive aid to help them cover their expenses.
“The Prescription Advantage program will fill some of the gaps that are not covered by [Medicare],” said Charles Sisson, executive director of Coastline Elderly Services. “[It] kind of fills in the holes.”
Seniors will be able to select a plan anytime between Nov. 15 and next May 15. For those who enroll before the end of the year, coverage will begin on Jan. 1. Those who miss the May deadline can still enroll, but will have to pay a premium penalty of 1 percent for each month after May they are not enrolled.
“It really behooves people to sign up for a plan so they don’t face a penalty down the road,” Dr. Yeh said. The new program will provide an average savings of around $1,000, according to Dr. Yeh.
Though the program is expected to provide a significant benefit to seniors, it is likely that navigating the complicated maze of options will be confusing to some.
“It’s very clear that this is revolutionary,” Sisson said. “But it’s something that is quite overwhelming to many, many seniors.”
Dr. Yeh recommended that all Medicare recipients, or their caregivers, prepare to make a choice by taking stock of their current prescription drug situation. She suggested that each person create a list of all the medications he or she currently takes, the costs associated with each of these and the pharmacies he or she uses.
“What I like to tell seniors is, ‘Don’t panic, you’ve got time to think this through,’ ” she said.
Once seniors have gathered the needed information they have several options. Online tools will be available at www.medicare.gov to guide users through the process of finding plans in their area that are affordable and cover all necessary prescriptions.
The less internet-savvy can call the Medicare help line or a local agency such as SHINE or Coastline Elderly Services (see sidebar). Trained counselors will collect information from the callers and help them select a plan that fits their needs.
“We have people that are trained to sit down with them, go over the various plans and . help pick the best plan for them,” Sisson said.
Counselors will outline what options are available to each person, based on the beneficiary’s needs and current Medicare coverage. Because not all plans cover all drugs, they will also help seniors make sure that they select a plan that includes all or most of their medications.
Coastline Elderly Services and SHINE are also running educational programs and information sessions.
The responsibility for selecting a plan, however, ultimately belongs to each individual, said Dr. Yeh, who used to work in emergency medicine.
“I used to see patients who got sick . because they weren’t taking their drugs, because they couldn’t afford it,” Dr. Yeh said. “For those who don’t have coverage-what a wonderful thing we are offering. But it doesn’t mean that they’re not going to have to act thoughtfully and make a choice.”
