Change is often challenging. For older adults concerned about their health and finances, change can be especially difficult. And Maine seniors making decisions about becoming part of the nation’s new Medicare Part D program, which offers coverage for most prescription drugs, may not be having an easy time of it.
They aren’t alone.
The Kaiser Family Foundation and the Harvard School of Public Health report that 43 percent of surveyed seniors haven’t decided what to do about enrolling in Medicare Part D. Most appear “stumped,” either because of the variety of available plans – averaging about 40 per state – or because they simply can’t get a handle on comparing costs and weighing the pros and cons of switching to a new Medicare Part D plan.
While the program goes into effect Jan. 1, 2006, our nation’s 42 million Medicare beneficiaries will still have time to explore options and make a decision before the initial open enrollment ends on May 15, 2006. While seniors need to decide for themselves what’s best, here are some things they, and the loved ones helping them make this important decision, should consider.
Get informed. Read the newspaper; listen to the radio; watch TV. This is a “hot” topic that’s in the media spotlight right now, so take advantage. People can also log on to Medicare’s web site, www.medicare.gov, for information and plan comparisons. For more information about Anthem’s Medicare Part D Plans, go to www.bmedicarerx.com.
For senior citizens unfamiliar with the Internet, their children or grandchildren can help. Health benefits companies, including Anthem Blue Cross and Blue Shield, and others such as Maine’s Area Agencies on Ageing are offering community forums where people can ask questions and get educational materials. Anthem Blue Cross and Blue Shield’s first round of free informational meetings held throughout the state recently were so well attended that it will hold a second round of informational meetings this winter. Seniors should watch their mailboxes or newspaper for details, and bring their questions to one of those seminars.
Seniors should be prepared to evaluate their own personal situation. Medicare Part D isn’t “one size fits all.” Is a senior covered by Medicaid, perhaps living in a nursing home? If so, he or she may be enrolled automatically in a premium-free Medicare prescription plan. Seniors with limited income might qualify for a reduced premium policy. Retirees who already have drug coverage through their former employers might be better off staying with their plans.
A senior citizen should also consider unique factors such as age, current health status, personal finances, and willingness and ability to accept risk. The number of drugs a person is currently taking is another factor. Even if a person doesn’t take a lot of medication, circumstances can change. Does the senior citizen have a chronic condition or disease that requires regular prescription medications? Do he or she belong to the state’s Rx Maine program? How much can the person afford to pay for deductibles and co-pays “out of pocket”? And what monthly premium can he or she afford? Plans are available in a range of prices. Anthem Blue Cross and Blue Shield, for example, is offering three options with varying co-pays and monthly premiums, ranging from $31.19 to $54.00.
A person should carefully review the formulary (preferred list of drugs) of each plan being considered. He or she can work with a physician to ensure that any drugs he or she adds or changes are on the formulary. While not every current medications may be listed, it’s likely that an equally effective alternative is available.
If a senior citizen currently has a Medicare supplemental plan with a drug benefit, he or she would likely save money by enrolling in Medicare Part D. Those keeping their Medigap plan who don’t join a Medicare Part D plan by May 15, 2006, will be subject to a monthly retroactive penalty if they choose to sign up at a later time.
The federal government believes seniors will ultimately like Medicare Part D and save money. But it falls to seniors, and the loved ones who may be helping them manage their health care needs, to make a wise choice about enrolling. The bottom line is that every Medicare beneficiary has to make a decision about prescription drug coverage by May 15, 2006. People are encouraged to do some homework and make the right choice.
George Siriotis is regional vice president of sales for individual accounts for Anthem Blue Cross and Blue Shield’s Northeast region, which includes Connecticut, Maine and New Hampshire.
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