By LEE BOWMAN
October 17, 2006
Although the marketing has been under way for weeks, most of the roughly 30 million beneficiaries who are already enrolled in Medicare Part D plans and are content with their coverage, don't have to worry about changing.
"If you are satisfied with your plan and want to stay with it, you don't need to take any further action,"' said Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services.
The government estimates that 83 percent of beneficiaries around the country have access to drug plans with lower premiums in 2007.
After getting a few months experience in providing the coverage this year, many plans are improving their coverage. The average number of drugs covered is expected to rise by about 13 percent, McClellan said in interviews with health reporters Friday. And people in most states will have 50 to 60 plans to choose from, including 17 plans being sold in all 50 states, up from nine this year.
In a figure tinged with controversy, Medicare says the average monthly premium for drug coverage will be $26 next year, up from $24 this year. Democratic critics in Congress say that calculation includes premiums paid to Medicare managed care plans that also provide drug coverage, which cover about 10 percent of enrollees. If freestanding drug coverage alone is counted, the average monthly cost rises to $29.
Still, most seniors have indicated in various surveys that they're generally pleased with their drug coverage, even with gaps in coverage and some restrictions on which drugs people get.
That doesn't mean they won't shop around a little for a better deal, though.
For instance, Florida beneficiaries will be able to choose from 58 plans that have premiums ranging from $10.20 a month to $83.70 a month. The plans carry a huge array of differences in out-of-pocket costs, deductibles, co-pays, coverage limits and range of drugs covered.
McClellan said about 300,000 low-income seniors will be forced to switch plans to stay in a subsidized plan with low costs, mainly due to changes in the details of certain plans rather than plans shutting down entirely. Those beneficiaries should get notices sometime this month about the need to find a new plan.
Everyone already enrolled in the program will get a notice of 2007 changes from their current plan. And while the deadline is Dec. 31, people are encouraged to sign up by early December to ensure they have a new drug plan card in hand to pay for prescriptions come January.
Medicare's basic plan pays 75 percent of seniors' drug costs up to $2,250 after meeting a $265 deductible. Coverage then stops entirely until drug costs reach $5,100, after which Medicare will cover 95 percent of costs.
There will be more plans that offer coverage for some or all costs incurred during that "donut hole" period, which affected about 10 percent of enrollees this year. Most plans will require that patients mainly use generic drugs during this period.
As with the original enrollment period, Medicare, the drug and insurance industries and senior advocacy groups are geared up to help the elderly and disabled people consider their choices.
"If you want to consider other options, we have enhanced the tools that make it easier to get the coverage that's right for you," McClellan said, presenting an update of the Medicare Prescription Drug Plan Finder Web tool on the Medicare.gov Web site.
It includes a monthly cost estimator that will allow users to chart how drug spending will go each month of the year under a specific plan and new features to compare plans based on price and benefit structure.
People without Internet access or skills can still use the computation tools by calling the Medicare hotline 1-800-633-4117 and working with a counselor or visiting local state health insurance assistance programs or workshops that are again being presented by various senior activist and support groups this fall.
Medicare is also sending out a new "Medicare and You" handbook this month, which includes tips on selecting a plan and an overview of options.
Another tool has been produced by associations representing health plans, drug stores and pharmacists, and will be distributed in printed form at drug outlets and online at www.healthdecisions.org/guide.
Another group of health-affiliated organizations is concentrating on getting the estimated 3 million low-income Medicare beneficiaries who didn't sign up for drug coverage last time but are eligible for subsidized premiums to enroll before a Dec. 31 deadline.
Unlike better-off beneficiaries who skipped enrolling, those eligible for subsidies face no late enrollment penalties. "But now we all need to reach out and make sure that people actually fill out the paperwork or apply online for this very valuable benefit," said James Firman, president of the National Council on Aging, one of the organizations promoting the signup.
Material about enrolling is available at www.AccessToBenefits.org; www.maprx.info, and www.nationalhealthcouncil.org/help
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Scripps Howard News Service, http://www.shns.com
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