Time is running out to find a Part-D plan

Making sense of Medicare prescription plans

For Kristy Davidson, things are getting better. The number of questions about Medicare's prescription benefit program have dropped to 25 calls per day. She was getting as many as 150 to 200 calls at her office shortly after the New Year's implementation.

Davidson is the Medicare and Senior Services advocate for the Northern Arizona Council of Governments (NACOG), the liaison agency for federal programs in the four Northern Arizona counties.

For many seniors, making sense of 44 different private insurance plans in the state and 10 national plans it is more than they can handle. Each of the private drug plans has its own premiums, formulary and set of rules, including the "donut hole". It makes you want to pull your silver hair.

The NACOG advocate says, "I have met some incredibly bright people that are confused by this."

Still not enrolled? Time is running out. Seniors have until the first of May to sign up for the so-called Part-D without any penalty. After that they must pay a penalty of one percent per month for every month they have not been enrolled. That can add up.

Janet Millsop, a pharmacist at Safeway Pharmacy in Cottonwood, says "it was rough in January but it's now very smooth. All the plans are now on line."

There were early instances when there was a lag between the private insurance firms and a patient's needs for prescription medication.

The first thing to check is a person's insurance coverage and what it provides, if they are covered through a retirement program, Davidson says "creditable coverage" from a former employer must be as good or better than the minimum standards required by Medicare Part-D.

Anita Rocca, Office Supervisor for AHCCCS in Cottonwood says some employers have advised that prescription benefit coverage may be better and have discouraged signing up for Part-D, which is a voluntary program. Some have also indicated that if a retiree drops his prescription coverage, the entire insurance policy may be cancelled.

Kristy Davidson says the first stop should be Medicare's Web site: Medicare.gov. There is information about all the programs available in Arizona and which medications are covered by each provider, the premiums and co-pay percentage.

That's important says Millsop. "Different plans cover different medications and a person may tolerate one antihistamine differently from another... Allegra, or Zyrtec, for example."

The website allows a person to enter his or her prescribed medications and see which insurance plan covers the most under each forumulary, the list of drugs that an insurer will cover under its plan.

People with a number of prescriptions may still find that some companies will not cover every medication and a person may have to pay for a drug from his own pocket, if it is outside a plan's list, according to Davidson.

"There is good and bad with every plan," suggests Millsop. She adds, "many people have been helped."

There are some exceptions. Those who qualify for both Medicare and AHCCCS are dubbed "dual-eligible" and often disabled or who fall into the lowest income levels. They now have a co-pay of one dollar for generic medications and three dollars for a brand name. That doesn't sound by much but Davidson notes that those with numerous medications or with meager resources find even that cost difficult.

"The Salvation Army in Cottonwood has been good about helping with those co-pays," suggests the pharmacist.

If a person is not computer literate and needs help figuring out the plan's Part-D maze, the governments toll-free phone can help. Davidson says the 1-800-MEDICARE number "can be more time consuming, but once you reach a live human, they can be incredibly helpful."

There are also volunteers. Volunteers visit the Verde Valley Senior Center in Cottonwood on the first and third Thursdays. They are at the Camp Verde Senior Center on the second and fourth Thursday. In Sedona, they visit the Adult Community Center Monday and the Sunset Village Mobile Home Park on Wednesday.

If you want to change Medicare Health Plans, a person may enroll with a different company only during an open enrollment period from Nov. 15 through Dec.31.

Davidson also cautions that there are people who will take advantage of vulnerable people and fraud is a concern. She says, while people will pay a premium for their coverage, there is never a fee to enroll. Never, she says, should someone give personal information to a solicitor who calls you.


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