Medicare officials say seniors should think ahead for new prescription plan

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By Jan. 1, millions of older Americans will begin getting significant relief for prescription drug costs through Medicare Part D.

But, what is Medicare Part D and how can it help seniors?

Medicare Part D is a result of the Medicare Modernization Act of 2003, which Dr. Mark Stratton, Pharmacy professor and Geriatric Pharmacy Program director at the University of Oklahoma College of Pharmacy, called the most revolutionary change to Medicare since its beginning in 1964.

"At last, a prescription program that will provide relief for millions of Americans," Stratton said. "But, people do need to be educated about the program so they can get the best plan for them."

Elders who sign up for the Part D benefits beginning Nov. 15 will see their benefits start Jan. 1, he said.

Stratton said older adults have until May 15 to sign up for the benefits without penalty.

Medicare will contact eligible individuals about enrolling in the program, complete with a list of all providers and plans in the fall.



Who is eligible?

U.S. citizens age 65 and older who are eligible for Medicare also are eligible for Medicare Part D, which was preceded by the Medicare discount cards, he explained.

The Medicare discount cards will be eliminated in 2006.

"Medicare Part D is significantly different from Medicare Part A or Part B in the respect that it has been privatized," Stratton said. "For standard Medicare beneficiaries there will be several prescription drug plans (PDPs) from which to choose.

"For seniors who are on both Medicare and Medicaid, they will automatically be placed in a PDP."

According to the act, multiple insurance and other companies can offer PDPs to seniors.

Older adults who are on both Medicare and Medicaid and other low-income, low-asset seniors will have extra help with their costs and will have low co-pays for their prescriptions.

For seniors who are not in the low-income categories, Medicare said the monthly premium will be about $32 per month, which slightly will vary according to the plan they select.



How much does it cost?

After the first $250 in annual prescription drug purchases, seniors annually can expect:

To pay 25 percent of their yearly drug costs from $250 to $2,250, with the plan paying the other 75 percent;

To pay 100 percent of the costs from $2,251 until out-of-pocket expenses reach $3,600; then,

To pay 5 percent of drug costs (or a small co-payment) for the rest of the calendar year after spending $3,600 out-of-pocket. The plan pays the rest.

If a senior already has prescription drug benefits through their insurance, they will need to prove their insurance benefits are better than the Medicare benefits, Stratton said.

"Signup begins on Nov. 15, but if you don't sign up by May 15, you will see an increase of 1 percent per month in the monthly premium," he said. "So, if you sign up on June 15, your monthly premium will be $32.52 per month and increase 1 percent monthly thereafter.

"It really is worth people's time to educate themselves about this program and make their decisions early."



How to learn more?

Stratton said there is more information available to older adults to use when looking at their options, recommending seniors use the Medicare Web site, www.medicare.gov, or the Kaiser Family Foundation Web site on Medicare, www.kkf.org, to help with their decision-making.

For more details, call Medicare at (800) 633-4227.

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