Trying to understand Medicare Prescription Drug Plan Part D

Millions of elderly Americans are refusing Part D Medicare drug coverage while the feds are trying to force all low-income people into it whether they like it or not.

Like a doctor making the rounds ­ Kristy Davidson, Elder Rights unit and Medicare/Benefits Counseling Coordinator, is traveling throughout northern Arizona to speak with the elderly about how they can ,receive help to look at their options for prescription drug coverage. Davidson is with the Area Agency on Aging under the Northern Arizona Council of Governments. Last Friday, she and Winslow NACOG Case Manager Tancy Coughlin came to the La Posada Hotel to reach out to Winslow-area seniors to offer them help in looking at Medicare drug plans.

Part D, as it is commonly referred to, was added to the Medicare program as of January 1, 2006. A $400 million campaign was incurred by the Bush Administration to promote the program because only 1.4 million elderly Americans have signed up to the program; a fraction of the amount the government was expecting to enroll.

Davidson admits that Plan D is a complicated program mired within another perplexing system. In fact, there are 10 federal Plan D plans and 44 Arizona Plan D plans that elderly Arizonans of low-income have to choose from. The government suggests that these people age 65 and older can go online to navigate their options on the government's Medicare website ­ not a likely scenario.

"One thing I have found that is helpful are grandkids. Now you can give them something to do on the Internet besides playing video games," Davidson said, but if not, she and Coughlin are available for assistance too.

A big part of these changes that the Bush Administration added in the Part D plan was a penalty clause to essentially force people to join if they do not already have prescription drug coverage.

Those currently age 65 and over who do not sign-up to Part D by May 15, 2006 will be penalized with a percentage of an increase on their premiums if and when they do decide to join. It will be a one percent increase for every month they do not join or a 10 percent increase on their premium for every year they do not join. Currently the average premium in Arizona is $24.62. When someone just turns 65, they will be given 7 months to join the program before these penalties begin.

"It is the insurance industry that pushed this. It is a business and they want people to be paying into it when they are healthier, not when it is almost too late," Davidson said.

The only people who will not be penalized are those who can afford health insurance coverage that are better than the Medicare options. Insurance companies are required to provide letters of proof stating if your "coverage is at least as good or better than the minimum Medicare requires." If you do not have this statement, insurance administrators must provide it to you.

Another thing Davidson warns about when joining Part D ­ be prepared for insurance providers to drop you. They consider this government subsidized Medicare program as competition to the conventional plans they offer.

There are so many plans where only certain medications are covered that it can become even more complicated when someone is on a variety of medications or on certain ones that fall-out of the guidelines, Davidson said.

"I talked to a man who had a Niacin prescription for his heart, but Medicare did not cover it because Niacin is a vitamin and the Part D does not pay for vitamins," she said.

The lowest of low-income in the country have lost the benefits of charity medications that the drug companies once provided. Now that the companies agreed to Part D, they also cut their donations to the poorest elderly in the nation with the expectation that they will be forced into this plan.

Now that many people will be expected to enroll or pushed into this program, Davidson warns that the elderly need to be aware of fraud. There are no fees to enroll in Part D. Don't give-out any information to someone who calls you on the phone ­ it is better to contact the plan providers and set up appointments to talk. No plan will ever need to know your credit card number. No plans are allowed to go door-to-door or come to your home uninvited. Part D is also automatically taken from Social Security distribution checks, unless otherwise requested by recipients.

"I discourage folks from doing that because if the payment is only a few days late, you can be dropped from the plan.

Part D is a large factor to elderly health coverage now; especially for those with low and/or social security incomes. NACOG recommends that the elderly contact them and avoid drug company sponsored seminars on Part D.

Those interested in getting free help to learn about prescription drug coverage may contact Tancy Coughlin in Winslow at 289 ­ 3341. She is also available to help with wills, trusts and client advocacy for nursing homes and assisted living facilities.

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