After years of wrangling, Congress finally passed a prescription drug benefit for senior citizens. The Medicare program will launch in January of 2006, but over the next several weeks, people who are eligible for Medicare will be bombarded with competing offers from private insurers.
On October 1, mailboxes will start filling with promotions for a variety of plans. There will also be ads on television and radio, in magazines and newspapers. There will be intense pressure to pick a program starting on November 15.
Those who don’t sign up within six months will have their premiums increase by
one percent per month. The longer you wait the more it will cost.
This kind of pressure will make some senior citizens very anxious, especially when they discover how complex the decisions will be. For one thing, each plan will charge a premium. Some may be as little $20 a month while others may be well over $30. Some plans will have deductibles or co-payments, while others won’t.
Here’s where it gets really complicated. The basic plan has a $250 deductible that you pay out of pocket before you get any drug assistance. Then you pay 25 percent of your prescription drug bills from $250 to $2,250 (not including premiums).
At that point, you are on your own. You pay 100 percent of your medication bills for the next $2,850. This is the so-called donut hole, where the Medicare program won’t cover you. Once you have shelled out $3,600, the Medicare drug benefit kicks in again. It is supposed to pay 95 percent of your prescription bills for the rest of the year. Of course, this does not include your monthly premiums.
Confused? Wait, it gets even more bewildering. Not all drugs are covered, and plans are allowed to change the drugs they approve at any time. (Seniors are only permitted to switch plans once a year, though.)
If your doctor prescribes a medication that is not on your plan’s official list, you will have to contact the plan to ask for an “exception.” If the plan says no, you are allowed to appeal the decision. (Good luck.)
Some plans may be very flexible in permitting people access to their prescribed medicines. Others may be bureaucratic and hard-nosed. You probably won’t know in advance which way your plan will be administered.
In theory, the government will help people sort through the confusion. It is preparing to roll out a Web site designed to compare various plans (www.medicare.gov). We’ll have to wait and see how easy it is to navigate. Those without access to the Internet can call 800-MEDICARE.
Of course, none of this will do you any good if you are not yet 65. If you are ineligible for the prescription drug plan but still struggling to pay for your pills, we have prepared a Guide to Saving Money on Medicine. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (60 cents), self-addressed envelope: Graedons’ The People’s Pharmacy®, No. CA-99, P. O. Box 52027, Durham, NC 27717-2027.
Millions of people are desperate for relief from high drug bills. The new Medicare plan may help, if they can figure out how to use it wisely.
The People's Perspective on Medicine