Seniors crowd Medicare forum
A standing-room-only crowd filled the Harrison County Commissioners Room last week for clarification and advice on Medicare prescription drug coverage which takes effect Jan. 1.
Ninth District Congressman Mike Sodrel sponsored the forum in response to concerns of constituents, many of whom are trying to select a prescription drug plan from the more than 40 that are offered.
Sodrel offered a sympathetic ear.
‘Sometimes there’s so much on the menu, you can’t make up your mind what you want to eat,’ he told the attentive crowd.
He told the seniors, as did others, to count on a trusted pharmacy for help in selecting the most beneficial plan. The prescription drug insurance, a first in the United States, isn’t provided solely by Medicare, but rather through private insurance companies. ‘We can’t sell any of the 42 programs,’ Sodrel said, ‘but we hope to help you sort out the (choices) and narrow it down.’
What may be best for one person may not be the best choice for another, mostly because not everyone takes the same medication. One plan may cover more of the medications taken by one person but not another.
Initial enrollment for Medicare recipients in a prescription drug plan began Nov. 15 and continues through May 15. Coverage begins Jan. 1 for persons who enroll this year. Enrollees will pay an estimated monthly premium of $35 in addition to the premium for Medicare.
Sodrel turned the program over to Larry Miller of Indianapolis, a SHIIP (Senior Health Insurance Information Program) expert from the Indiana Dept. of Insurance, to deal more specifically with the issues.
Some standards apply to all of the plans. Those include an annual deductible of $250, coverage of 75 percent of prescription costs between $250 and $2,250, no coverage for drug costs between $2,250 and $5,100, after which enrollees will be required to pay the greater of a co-payment ($2 for generic drugs or $5 for brand-name drugs) or coinsurance of five percent.
Seniors who already have adequate prescription drug coverage may continue that coverage. If that coverage offers the same or better benefits (which would be verified in a letter from the insurance company), a penalty would not be imposed for joining late, Miller said. That letter should be kept with other important documents.
Also, persons may change plans on an annual basis between Nov. 15 and Dec. 31, provided they maintain continuous coverage.
Persons who are on Medicaid, the state’s insurance plan for the poor or low-income elderly or disabled who are also on Medicare, the federal medical coverage for retired seniors, are automatically assigned to a drug plan, Miller said.
But Harrison County Community Services director Shirley Raymond said those persons who receive notice that they have been automatically assigned to a plan should still check to be sure their drugs are covered.
‘My fear is that those people will go to the pharmacy in January, expecting to pick up their drugs and have them covered, which is most likely ‘ as far as we have seen ‘ not the case,’ Raymond said.
If the enrollee then decides to change plans, they may do so, but it wouldn’t take effect until the next month, she added.
For assistance, persons are welcome to call Geneva Sams at Community Services, 738-8143, or SHIIP at 1-800-452-4800.