Tips To Beat Drug Plan Confusion

Susan Page
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Wednesday - May 17, 2006
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Got drugs? Cheap? Only if you’ve signed up.

Let’s hear it for President Bush and the Republican Congress. They have delivered on a very good Medicare prescription-drug plan for seniors. Here’s hoping you’ve registered before the May 15 deadline because the savings on your prescription medicines will be healthy.

Seniors on fixed incomes shouldn’t have to choose between buying food or buying their diabetes medicine, so in late 2003, Republicans pushed this drug plan legislation through Congress despite heavy opposition from Democrats. Kudos to them for doing what previous administrations had been unable to. And, the often maligned pharmaceutical companies, according to financial experts, will be making less money for each drug they sell because drug plans buy them at a discount which in turn is passed on to seniors.

Unfortunately, governments reports say, as of this writing, 40 percent to 50 percent of eligible seniors haven’t signed up. Many who have bemoaned their medicines’ high cost aren’t taking advantage of what could ultimately mean a 95 percent savings.

Why? I think there are three reasons: procrastination, confusion and passiveness. I can really relate to the first two. The third may require its own separate column.

The truth is that if it weren’t for my friend Kathy Sparlin, I’d still be scratching my head over insurance plan choices for my own mother. For months I simply couldn’t decide which plan to choose, so I kept moving the task to the bottom of my to-do list.

Last January when I saw Kathy at a UH Volleyball game, she was a little agitated and on a mission: “I don’t want anyone to have to go through what I’ve just experienced.” She’d been working on her mother’s MedicareRx plan all day and was frazzled.

I was worried. Kathy’s an accountant. If she’s having trouble figuring all this out, what will I have, a complete mental breakdown? Fortunately, I didn’t find out because she was willing, even eager, to hold my hand through the online registration process.

Actually, she had already done the hard part for me by pre-screening the different plans my mother’s pharmacy accepted. She looked for: premium cost (copay vs. no co-pay) and what price Mother’s Alzheimer’s drug, Exelon, costs with each. Was the insurance company well-known or a new carrier on the block? Were there any hidden costs lurking between the lines?

Once on the website - - it was a breeze. The site is very user-friendly. However, Kathy, who is mostly positive about the new program, fears the breeze could turn into a hurricane if we don’t pay attention.

“It’s the gap that can get you,” Kathy warns.

The costs are calculated on how much is paid out for drugs within a year. On Mother’s plan (without co-pay), she pays 25 percent of the drug cost and the insurance carrier pays 75 percent. When a total of $2,250 has been paid out, then she’ll return to paying 100 percent (called the Medicare “gap”) until the payout reaches $5,100. Then she’ll only have to pay 5 percent for her drug. At year end, calculations start all over again. Even with premiums her savings will be at least half of her current payment. But we must watch for the “gap” period.

Low-income individuals (under $14,700 annually), those who need this coverage most, are signing up slowest, but are exempt from paying late fees or penalties for missing the May 15 deadline. In fact, they have until Dec. 31, 2006. Hopefully, these folks will call 1-800-MEDICARE, open 24 hours a day, seven days a week for assistance. Or find someone to help them go online at if they’re not able themselves.

If you know an elderly person at church or in your neighborhood who you think might have trouble signing up for this, why not ask them, “Have you signed up for the new Medicare drug plan? If not, I’d be happy to help you do so.” Kathy did that for me and my mother, and I’m not even that elderly - yet!

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