For years, Maine’s seniors have been boarding buses, surfing the Internet and visiting the post office in search of cheaper prescription drugs.
With the recent rollout of a long-awaited Medicare drug benefit, many folks are wondering whether they should enroll at all and, if so, how.
Not every one needs to sign up, and experts in Maine familiar with Medicare Part D say not everyone necessarily should.
• Upper and middle-income seniors on employer-sponsored discount plans should compare potential savings to what they pay now.
The federal government is offering incentives to employers to continue their drug insurance programs. One big employer, the state of Maine, expects to save $2.8 million on state retirees’ drug plans because of those incentives.
• Many lower-income Mainers may find the Medicare plans more costly than what they now pay through state subsidized programs. They also should do cost comparisons.
• And for those who have no private or state prescription plan, they first will want to determine if they qualify for state programs. If they don’t, they should review the Medicare plans available and see if they will save money.
Plenty of confusion to go around
That is, if they can figure it out at all. With a seemingly unlimited number of medications and 41 plans available to Mainers each offering different benefits, the decision promises plenty of confusion.
The government offers a Web site that will find the best plan according to each individual’s circumstances, but navigation isn’t easy. Many seniors have relied on elderly outreach services in their area to help with the search.
Experts admit the prospect of finding the right plan in Medicare Part D poses a challenge.
“It’s a tough time for seniors right now,” said Jude Walsh, who heads up prescription drug programs in the Governor’s Office of Health Policy and Finance.
“I don’t have it figured out and I’ve been working on this for two years. It’s pretty darned confusing.”
What’s all this mean to Mainers?
The good news is that the Medicare plans must offer drugs that cover all drug categories, such as medicines for heart disease or high blood pressure. The Maine programs only cover 14 categories, not including mental illness or depression.
The bad news is that the number of drugs offered within each category is drastically different. Where Maine’s programs offer a choice among 6,000 different drugs, Medicare insurers are offering as few as 450 choices.
It’s up to the person enrolling to make sure their particular medicines are covered under a plan.
How do you find the right plan?
• The Medicare Web site. Either on your own or with an experienced assistant affiliated with an elderly organization or health-care organization.
• If enrolled in a state program, call the state’s hot line at 1-866-RxMaine (796-2463.)
Critics point to two major flaws in the Medicare drug benefit.
• All Medicare plans pay only up to $2,250 a year. After that, seniors must pay the total cost of their drugs until they’ve spent $5,100.
That means someone who spends more than $5,000 on prescription drugs a year must pay a $250 deductible (on most plans,) plus $2,850 out-of-pocket. That doesn’t include monthly premiums for the Medicare plan (from $20 to $65) and co-pays, often 25 percent of the drug price.
• If you’re not eligible for drug assistance through a state program, Medicare may not allow your secondary private insurance to pick up the cost of any part of your plan.
In Maine, officials expect to be able to help those enrolled in the state’s Drugs for the Elderly Program to cover all of their premiums and help with deductibles, co-pays and the $2,850 gap in coverage.
Experts urge seniors to be aware of the possible penalties if they wait too long to enroll.
• The plans go into effect on Jan. 1, 2006. Those not enrolled in a plan by May 15 will be assessed a 1 percent penalty per month if they later enroll. That means, if someone decides to enroll in May 2007, he or she will pay 12 percent more for the plan.
• Seniors who don’t have drug coverage now and don’t need medicines but want to avoid a penalty can sign up for a plan with the cheapest premium and the highest deductible. When the time comes that they are prescribed drugs, they can check their plan against the others to make sure it’s the best one. If it isn’t, they can change plans once within each calendar year.
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