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Monday, November 29, 2021  

Making Difficult DecisionsPublished 9/19/2005

Starting November 15, 2005, seniors and disabled persons on Medicare can begin enrolling in Medicare Part D.

Eighteen companies have signed up with Medicare to offer prescription drug plans to seniors. In addition, there will be a minimum of three and possibly more Medicare Advantage (HMO) plans available in some regions of Colorado.

The Colorado Gerontological is sponsoring "Medicare Part D – New Benefits, New Rules" for seniors to learn more about the prescription drug plans and Medicare Advantage plans on October 22, 2005, at the Colorado Convention Center, 14th and Curtis, Denver.

The lectures run from 9 am to noon. From noon to 2:00 pm individuals are encouraged to do comparison shopping by visiting with the Medicare Advantage Plans and the Prescription Drug Plans, getting more information through the Medicare Health Plan Finder, and learning more about Part D.

Enrolling in Medicare Part D means signing up for a Prescription Drug Plan or a Medicare Advantage Plan (HMO) with prescription drug coverage. Individuals who enroll after May 15, 2006 will be subject to a one percent per month penalty for every month they delay in enrolling.

To help with the decision making, seniors need to be enrolled in Medicare Part A or B and have a list of their medications, preferably from the pharmacist. Seniors also need to know their annual income and resources, as many will be eligible for extra help in paying the monthly premiums, co-payments, and deductibles.

Depending on the prescriptions and the pharmacy, some seniors will need to make a decision about which pharmacy from which they want to purchase their prescriptions, as they may face different co-pays from different pharmacies.

Some seniors will need to enroll in Medicare Part D, while others will not. To begin this difficult decision, seniors may start by trying to determine their circumstances using the following groups as a guide.

Group I. Individuals who are on Medicare and currently receive Medicaid through Supplemental Security Income, Old Age Pension and Home and Community Based Services will automatically be enrolled for the "extra help" to pay for premiums, co-payments, and deductibles. All individuals will automatically be enrolled in a Prescription Drug Plan, however, they need to review the formulary and decide if the medications they are currently taking are on the formulary of the Prescription Drug Plan. Individuals can enroll in a new Prescription Drug Plan on a monthly basis if it does not meet their individual needs, regardless of where they live. Individuals will be responsible for co-payments of $1 for generics and $3 for name brands.

If individuals are currently enrolled in a Medicaid/Medicaid HMO such as Colorado Access, Evercare, or Total Longterm Care, they will be automatically enrolled in their program. These individuals may be responsible for co-payments of up to $3 for generics and $5 for name-brands.

Individuals who are on Medicaid in a nursing home will be automatically enrolled in a Prescription Drug Plan. The pharmacy that currently provides the medications to the nursing home will usually subcontract with the Prescription Drug Plan to provide the medications. Individuals will not be responsible for any co-payments, deductibles, and premiums. Individuals who are on Medicaid and Medicare in an assisted living facility will have to pay a small co-payment each month, but can change plans monthly.

Group II. Individuals who are on the Medicare Savings Plan (QMB,SLIMB, QI-1) or with incomes below $1197 ($1604 for a couple) and resources below $11,500 ($23,000 for a couple, including burial coverage) are eligible for extra help with their premiums, co-payments and deductibles. Seniors will need to complete the application form for the extra help and send it to Social Security.

In addition, they will need to enroll in a Prescription Drug Plan or a Medicare Advantage Plan (HMO). If the individual is currently enrolled in a Medicare Advantage Plan (HMO), the Medicare Advantage Plan will automatically enroll the individual in Part D, however, the formulary for the plan to which they are automatically enrolled may not cover all of their current prescriptions. Individuals can only change plans monthly.

Group III. Individuals who are currently enrolled in a Medicare Advantage Plan (HMO) can be automatically enrolled in Medicare Part D. The Medicare Advantage Plan will facilitate enrollment in a plan similar to the plan in which the individual is currently enrolled. Co-payments, deductibles, and premiums will vary by Medicare Advantage Plan.

Individuals who choose to enroll in a Medicare Advantage Plan for the first time will need to select the prescription drug plan with the formulary, co-payments, deductibles, and premiums that best meets their current needs. Individuals who delay enrolling by May 15, 2006 will be subject to the penalty.

Group IV. Individuals who currently have a Medicare Supplement (such as AARP, Mutual of Omaha, Bankers Life and so forth) without prescription drug coverage and who are not part of an employer group plan, will need to enroll in a Prescription Drug Plan or a Medicare Advantage Prescription Drug Plan, if they wish to keep their Medicare Supplement to cover their hospital, physician and other health care costs. The formulary, premiums, co-payments, and deductibles will vary depending on the Prescription Drug Plan that is selected. If the individual meets the low income guidelines, they should also enroll in the "extra help". If the individual does not enroll by May 15, 2006, they will be subject to the penalty.

Group V. Individuals who currently have a Medicare Supplement that offers prescription drug coverage (such as Plan H, I or J) can keep this coverage, however, they may want to enroll in the Medicare Supplement A, B, C, D, E, F, G, K, or L with a guaranteed issue with the same company before August 2, 2006 and enroll in a Prescription Drug Plan from another company before May 15, 2006, as well. Most likely, the cost of the Medicare Supplement and the Prescription Drug Plan will be less expensive than the Medicare Supplement H, I or J.

In addition, the individual will not face a penalty if they enroll late in Medicare Part D by dropping Plan H, I or J before May 15, 2006.

Group VI. Individuals who are in employer group plans will need to check with their employer. If the employer has applied to the federal government for "creditable coverage" to continue offering their current prescription drug plan, the individual can continue to receive their prescriptions from the employer. The individual will not be subject to penalties if they enroll late.

Group VII. Individuals who receive TRICARE as a military retiree or Veterans Administration benefits will not need to sign up for Medicare Part D. The coverage they receive through TRICARE or VA is considered "creditable coverage" and TRICARE and VA will continue to offer their current prescription drug plans. The individual will not be subject to penalties should they decide to leave TRICARE or VA and enroll in Medicare Part D in the future.

Individuals who want to visit with experts from Medicare, the Access to Benefits Coalition, the Division of Insurance, Social Security Administration, and the Denver Department of Social Services, Senior Answers and Services, as well as the Medicare Advantage Pans and the prescription drug plans should attend the free program at the Colorado Convention Center on October 22. Reservations are suggested by calling 1-866-416-0659, as well as to receive a schedule of the sessions.

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