Piecing Together The Medicare Prescription Drug Puzzle

By Jan Howard

To say there is confusion among seniors and others about the newly offered Medicare prescription drug discount card is an understatement. In some cases, it is a program that is going to need explanation after explanation before it truly is understood.

To help seniors, their families, and others understand the new program that became effective in June, Dawn F. Macary of the Western Connecticut Area Agency on Aging, Inc (WCAAA) in Waterbury discussed the latest updates on the discount cards during a program last week at the Newtown Senior Center on Riverside Road.

Some questions following the program were indicative that for some individuals the program continues to be an enigma. But help is available through the WCAAA to aid seniors in their card selection. A personal information form can be requested by writing WCAAA, 84 Progress Lane, Waterbury CT 06705 or calling 203-757-5449 or 800-994-9422.

When the form is completed, seniors should return it to WCAAA, which will respond with a comparison of drugs from one pharmacy to another.

Seniors can also obtain information by calling 800-Medicare or go to www.medicare.gov.

The Medicare-approved drug card program is available in 2004 and 2005 and will be optional to all Medicare beneficiaries. It will offer savings of up to 25 percent on prescription drugs.

“The card is voluntary. It will cost no more than $30 for one card per year,” Ms Macary said. She noted people on ConnPACE should stay on it.

A pamphlet from the United Seniors in Action states that the Department of Social Services is going to select the card(s) that will be endorsed for the ConnPACE program and will then notify seniors which are approved. These would be the only cards able to be used with ConnPACE.

Low-income seniors with incomes less than $12,569 for an individual or $16,862 for a couple enrolled in ConnPACE and who are also eligible for Medicare will be required to get a prescription drug discount card, which will be paid for and chosen by ConnPACE.

Low-income seniors in 2004 and 2005 would receive a $600-a-year subsidy to defray their drug costs. Co-pays would be five to ten percent.

The Medicare-Approved  Drug Card

The Medicare Modernization Act was passed on December 8, 2003. It has two major components, limited assistance with prescription drugs that became effective in June and the Part D Drug Program that will be effective January 1, 2006.

The discount cards available now would take 10 to 25 percent off the retail prices of prescription drugs. The cards, offered by private companies, will have a different list of covered drugs and discounts. The cards must be Medicare approved with a Medicare Seal on the card.

The confusion is caused, Ms Macary said, because there are approximately 44 cards to choose from in Connecticut.

Each card has a different formulary of drugs available, she said. “Each will have specific drugs for which discounts are offered,” she said.

“There is no time limit to sign up,” Ms Macary said.

Individuals can enroll in only one program at a time. Enrollees will not be permitted to change discount card programs until November 15 to December 31.

She noted, however, “Card sponsors can change prices weekly, drop the drugs they cover at any time, and change pharmacies.”

Nonetheless, “You will definitely be saving money,” Ms Macary said, “but not as much as you hoped to.”

Availability of the prescription discount card ends when Medicare’s voluntary drug benefit (Medicare Part D) becomes effective.

 

Prescription Drug Program

(Medicare Part D)

The Prescription Drug Program (Medicare Part D) takes effect January 1, 2006. Enrollment begins November 15, 2005, through May 15, 2006. If individuals do not sign up at this time there may be a penalty of one percent per month.

The anticipated premium is expected to be $35 per month ($420 per year estimate).

The standard benefit includes $2,250 initial coverage limit. There is a deductible of $250. Once an individual has paid a doughnut hole gap of $2,850 out of pocket, the plan pays 95 percent of drug costs.

“This is meant for catastrophic illness,” Ms Macary said.

WCAAA develops, manages, and provides comprehensive services for seniors, caregivers, and individuals with disabilities to maintain their independence and quality of life.