Confused About Medicare Part D? Welcome to the Club
2/06
Describing the new Medicare Part D rules as confusing is being way too kind. Part D rivals the US Tax Code as being one of the most incomprehensible pieces of legislation with which Americans have to deal. The idea behind Part D, providing seniors with comprehensive prescription drug coverage, was certainly a great idea. In theory, one would think that providing subscription drug coverage to all Americans should not be that difficult to accomplish. Enter the large pharmaceutical companies and the millions of dollars of lobbying funds they can expend, and what you have is a complete mess that is going to cause a tremendous amount of grief for seniors trying to navigate through this system.
The main obstacle for seniors wishing to enroll in Medicare Part D is that there is no one set plan. Part D is a series of private plans with various pharmaceutical companies. In New York State, seniors have the option to enroll in one of forty three different plans. In addition, there is no one set price. Each plan, even those carrying the same medicines, have different premiums that must be paid in order to enroll in the plan. To add further confusion, not all medications are available in each plan.
As a senior looking to enroll in Part D, the first step you must take is to list the medications that you believe you may require throughout the year. Then you have to find a plan that carries your medications. Keep in mind that many common medications such as Lipitor, a drug used to block the production of cholesterol, are not available in any of the plans because they are too expensive. Once you plans which carry your medications, you have to look at the monthly premiums, which can vary from $20.00 to $75.00 and weigh what option is best for you. In selecting a plan, you should also keep in mind that you will have to go to a pharmacy designated by the plan. You should also beware that the pharmaceutical companies can remove any medication from the plan by providing 60 days’ notice. Thus, if too many people are using a particular medication or the medication becomes too expensive, the pharmaceutical company will simply remove it from the plan.
Seniors must also consider the enrollment deadlines and the penalties they may face if they do not enroll in a plan. The next enrollment deadline is May 16, 2006. If you do not enroll in a plan by this date, there will be a 1% penalty per month added to your premium when you do enroll. Even if you are currently not taking any prescription medicines, it may be worth considering enrolling in the cheapest plan possible so that you will not have to face the penalty of increased premiums somewhere down the road. You can always change the plan in which you are enrolled during a subsequent enrollment period.
Seniors who currently have a group health insurance plan in place from a former employer must be careful. If this group plan provides what is known as “creditable coverage,” enrollment in Part D may result in automatic termination from the existing group insurance plan.
Navigating through the Part D rules will take a tremendous amount of work and patience. Over the past several months Seniors have been bombarded with newsletters, brochures and promotional materials from companies seeking their enrollment. The best source for information can be found at the medicare.gov website. For New Yorkers, one of the plans you should consider is the Elderly Pharmaceutical Insurance Coverage (EPIC) Plan. This plan has certain maximum income (not assets) criteria but is one of the better plans for comprehensive coverage.