Drug coverage must be studied before decisions are made|[11/20/05]
Published 12:00 am Monday, November 21, 2005
Sixty-nine-year-old Irene Reeves takes nine prescription drugs daily and she’s looking for any help she can get with the $500-a-month cost.
“I’m scratching pennies like everybody else,” she said.
Reeves and her husband, J.C. Reeves, who takes five medicines a day and pays $300 a month, are like many senior Americans – begging for answers to the federal government’s new Medicare Part D prescription drug coverage.
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Confusion seems to come hand-in-hand with the new plan, which goes into effect Jan. 1. The coverage is available for everyone with Medicare, regardless of income, health status or prescription drug usage. But, it’s not as simple as some may think.
“I’m going to the drug store and get them to answer questions,” Mrs. Reeves said. “I’m so confused, but I’m going to look into it before I make a decision.”
Medicare prescription drug coverage is insurance that covers brand-name and generic prescription drugs at participating pharmacies. The prescription drug plan was passed by Congress about two years ago to provide protection for people who have high drug costs.
Signup for the program began Tuesday and will continue at least through May 15. A bill in Congress now would extend the deadline six months. A late-registration penalty will cost 1 percent a month for each month it is delayed.
S.C. Thomas, district manager of the Social Security Administration in Vicksburg, said, as with anything new, problems are bound to arise.
“There are too many ‘if’s.’ As the program progresses, Medicare and Congress will be making modifications and changes,” he said. “There will be problems. You can’t come up with a perfect plan. We are all subject to having to adjust to change, but this covers us where there is doubt.”
Thomas is encouraging people to make educated decisions before signing up for Medicare’s new coverage.
“You have to make an educated decision…everybody’s situation is different,” he said. “There are a lot of plans – call and ask if they cover the drugs you take, then find out how much.”
Thomas has been providing help to locals who are having a hard time figuring out the new coverage, which has almost 40 individualized prescription drug plans in Mississippi from 15 companies.
Not all drugs are covered, not all deductibles are the same and not all Medicare users will benefit. That’s why Thomas is encouraging all qualified locals to find the right plan for themselves.
“It’s an option because it carries a premium, which means you have a choice – to take it or not take it. If so, you need to decide what provider,” he said. “There are a lot of decisions.”
When making a decision, Thomas said those qualified should visit their pharmacist with a list of all medications taken.
“They will tell you which will be covered,” he said. “Not all medicines are equal and not all are covered.”
Pharmacist Joe Gerache Jr. of Corner Drug Store said he and other area pharmacists will try to help their customers sign up for plans before they are penalized.
“It’s so much information in such a short period of time – it’s really confusing,” he said. “We want to present them with the highlights so they know what to do and know what to expect.”
He said many customers older than 65 have already come in with questions. What he and fellow pharmacists will do to help customers is help find a plan that fits the customer, based on the medicines they are taking.
Tracie Hale-Smith, another local pharmacist, said one wholesale drug company is helping small-town pharmacies come up with a list of acceptable plans.
The standard of Medicare Plan D is a $250 deductible paid before Medicare will pay for prescription medications. Premiums average about $38 a month. A co-pay, averaging $15, will also be required for prescription medicines.
After the deductible is paid, Medicare will then pay 75 percent of medicines, up to $2,250. Once $3,600 has been spent out-of-pocket, Medicare will pay 90 to 95 percent of the cost.
Those who have Medicaid in addition to Medicare, will be signed up for Plan D automatically and will not have to pay any deductibles, co-pays or premiums, Thomas said. But, they are still encouraged to join a provider who suits their needs. If not, Medicare will choose one for them.
For Medicare beneficiaries who are not on Medicaid, but lack the necessary funding to pay deductibles and premiums may be qualified for further assistance. Thomas said anyone applying for drug coverage should fill out a request for a subsidy.
“I’m encouraging people to apply for the subsidy. You never know, you may be covered by a percentage,” he said. “You don’t know until a decision is made by Medicare. If you don’t apply, you can’t be notified if any changes occur. The law is subject to change.”