Seniors beware of the Medicare prescription drug plans. It started out as a simple plan that offered two or three options for Medicare recipients to purchase their medications. But competing insurance and drug companies have complicated the initial idea.”It was meant to be a simple plan … but then the prescription drug companies got into it and the insurance companies … in Colorado, we now have 17 insurance companies offering 44 different drug plans,” said Lisa Hietala, a representative for PacifiCare Secure Horizons, a health insurance company.Hietala spoke to Medicare recipients at the senior center on Hancock Avenue. She cautioned seniors not to buy the first prescription plan that comes their way. “While you may receive a notice in the mail from AARP, PacifiCare or any other company who says their plan is the best, if the plan only covers five of the 10 medications you take, it may not be your best choice,” she said.Hietala explained the drug plans: In Colorado, seniors pay a monthly premium, ranging from $8.52 to $65. “With the $8.52 monthly premium, there is a $250 annual deductible, then the plan covers 75 percent of your prescription costs, meaning you pay the remaining 25 percent,” she said. After incurring $2,250 in drug expenses, those who purchased this plan will have to pay for 100 percent of their prescriptions until those expenses amount to $5,100. At that point, the insurance company picks up 95 percent of the insurance costs.This is known in the insurance business as “the doughnut hole,” Hietala said. The deductibles are annual, and she cautioned seniors against buying the lowest priced plan unless they take few prescriptions or can afford to pay more than $3,600 a year for medication in the event of a serious illness.Seniors can determine which plan is best for them by visiting www.medicare.gov. Based on the individual prescriptions, Medicare will list the plans that cover those medications, starting with the lowest-priced plan. Hietala said seniors need to check the premium, deductible, co-pay and “doughnut” to determine the actual costs of the plan.Seniors who don’t have access to the Internet can call 1-800-MEDICARE (1-800-633-4227). The phone line is open 24/7. Hietala recommended calling late in the evening or early morning because people have reported the lines are usually busy during daytime hours.The prescription drug plan is an option and seniors can opt out. However, if seniors do not enroll before May 15, 2006, a 1 percent penalty will be attached to their monthly premiums. There are only certain enrollment periods; the next one is scheduled for November 2006.Hietala said veterans and family members receiving drug benefits through TRICARE for Life (military insurance) should not enroll in any Medicare plan. Veterans who have to purchase some drugs on their own should enroll, she said.People who retired from large companies, such as IBM, may have better drug benefits that Medicare is offering. Those companies should have notified retirees explaining they can continue using their current plan, Hietala said. “There is nothing you need to do but keep that letter, which shows you have credible coverage.” If the company retirement benefits are cancelled, senior can then enroll in a Medicare plan without the 1 percent penalty, she said.Seniors who currently have Medicare supplemental prescription plans, referred to as “H,” “I,” or “J” plans, are allowed to continue using these plans, but they are not considered to be a “credible” Medicare plan, and those seniors will be subject to the 1 percent penalty if they don’t choose one of the 17 insurance plans by May 15.People on Medicaid who didn’t pick a plan by Dec. 31, 2005 were automatically enrolled in a plan. Medicaid recipients only have six plans to choose from, and, although each plan’s premium is the same, the plans cover different drugs. Medicaid recipients should choose their own plan, Hietala said.Another warning to seniors: If they are enrolled in Medicare Advantage plans, such as PacifiCare Secure Horizons, Kaiser, Colorado Access or Humana PPO, their prescription plan must be purchased through those companies, or their Medicare supplemental health insurance will be discontinued.Finally, the AARP and Hietala are warning seniors about scams associated with prescription drug coverage. If callers identify themselves as Medicare representatives, hang up, Hietala said. Do not give financial or personal information to anyone over the phone, including insurance sales people. When attending an insurance sales seminar, take the information home, read it over and check the Medicare Web site, or call Medicare to determine if it’s the right choice for your needs.Visit www.medicare.gov.
