One from column A & B; 44 from column D
Program explains ins and outs of Medicare prescription drug program
BY LINDA DeNICOLA
Staff Writer

LINDA DeNICOLA Ann and Bill Crawford, Oceanport, attended a seminar on the new Medicare prescription drug plan.

Getting through the intricacies of Medicare’s new prescription drug program is like forcing yourself to take foul-tasting medicine because it will eventually make you feel better. In this case, it may save you money.

But there is so much confusion and so little time to figure it out. Although the program is considered voluntary, by May 15 every person who receives Medicare, and is not receiving drug benefits through their workplace, needs to sign up or face a penalty if they decide to sign up later.

Over 25 percent of the state’s seniors live in Monmouth, Middlesex or Ocean counties, but according to Congressman Frank Pallone Jr. (D-6), the Centers for Medicare and Medicaid Services is not currently planning on holding any informational forums on its Medicare prescription drug plan in these counties.

Last week, he sent a letter to the CMS asking the agency to hold an informational forum in central New Jersey.

In the meantime, Ocean Township resident Jim Newman took it upon himself to put together an informational seminar at his synagogue in Tinton Falls.

The seminar, which included six speakers, was held on Jan. 19 at the Monmouth Reform Temple in Tinton Falls where Newman, a retired chief financial officer, is president of the Brotherhood.

Newman said he put the seminar together because “there is so much apprehension about this program. What people need to know about the new Medicare prescription drug coverage is confusing and daunting.”

Ann and Bill Crawford, Oceanport residents, were among the 30 or so people who attended the seminar. Ann said she had already signed up for Medicare Part D and had picked her carrier, but after hearing what was said at the seminar, she wanted to change plans.

The information that impacted her decision is called the Coverage Gap, or “donut hole.” In an AARP brochure, the Coverage Gap is described as just that, a gap between the initial coverage limit, which includes a $250 deductible after which the plan covers 75 percent of the next $2,000.

In other words, the recipient pays $750 out of pocket. To fill in that gap, some drug plans offer extra coverage that may narrow or eliminate the gap, albeit at a higher premium.

Although the Crawfords found out that they had to change their coverage, they were still unsure about whether they could do it now or if they had to wait for the next enrollment period, which is November. After inquiring at the end of the seminar, they found out that they can re-enroll once as long as they do it before the May 15 deadline.

Ann said that even though it is very confusing and complicated, she and Bill had saved more than $1,000 each under the Medicare Part D program. And when they switch plans, they will be able to save even more.

There were a number of speakers representing a variety of organizations. They included representatives from several private insurance plans that Medicare has approved. They include: Bill Revman, president of Millennium Planning; Dan Toner, director of employee benefits for Future Financial Planners; Steve Archer of Aetna

Insurance; and Bill Mayer, New Jersey communication coordinator for AARP.

In addition, the state and county were represented by Trish Kaciuba, of the state Department of Health and Senior Services, and Barbara Rutan, director of client services at the Monmouth County Office of Aging.

What makes picking a plan so daunting is that there are 19 insurance carriers and 44 plans to choose from in New Jersey, and the biggest problem may be finding a company that covers all of a senior’s prescriptions.

Mayer tried to simplify the process for people in the audience. He told them to sit down in front of their computer, or at their kitchen table with a telephone, and make a list of all the prescription drugs they are taking and their dosage amounts. If they are using a computer, he advised them to go to the Web site www.medicare.gov and compare plans to find out which is best for them.

People can do the same thing by calling Medicare 1-800-633-4227 and can also get information from the AARP site, www.aarp.org.

“It should only take about 15 or 20 minutes to find out which is the best plan for you,” he explained, adding that he applied online and his wife applied by telephone.

“It was very efficient either way,” he said.

One man in the audience brought up one of the issues related to finding one plan that fits all of one’s needs. What happens if you take 10 different drugs and five are covered by one company and five are covered by another, he asked.

Mayer said there is a lot of misinformation about the ability to find a plan that covers all of one person’s drugs.

“Most companies’ formularies include 90 to 95 percent of drugs on the market,” he said.

That may be true, but according to a Medicare update on the Science and Health Web site for the PBS commentary program, “NOW,” there is a category of drugs commonly used to treat anxiety, insomnia and seizures, that is not covered under the new plan. They include drugs like Zanax, Valium and Ativan, which are the 11th largest therapeutic class of drugs based on total dispensed prescriptions.

Toner, who said he is an independent health agent, talked about the Medicare Advantage Programs, which wrap all of the components of coverage, Part A, Part B and Part D, into one package. With a Medicare Advantage Plan, he said, an individual can simplify his or her coverage and carry one card instead of three.

Rutan spoke last and tried to synthesize the information given earlier.

She said, “Everybody is confused. I compare it to buying a car. You have to do your homework.”

She added that there is help available and recommended that people contact the local SHIP (State Health Insurance Assistance Program) counselor. In Monmouth County, contact Family & Children’s Services, (732) 728-1331.

SHIP provides free, objective, confidential help to New Jersey Medicare beneficiaries who have problems with, or questions about, Medicare, Medigap, Medicare Advantage plans and long-term care insurance.

Rutan said her office has just gotten some grants to hire temporary counselors who will meet with people in their homes.

Because many of the questions from the audience concerned the Credible Coverage letter, she said, “that letter is like gold. Put it in your safe deposit box or some other safe place. Don’t lose it.”

The Creditable Coverage letter is sent to current or former employees who have prescription drug benefits from an employer. The employer, or union, is required to send a written notice saying whether or not the coverage is creditable, that is, at least as good as Medicare’s. Employees should have received that letter by the end of October.

People with a Creditable Coverage letter do not have to sign up for Part D, but everyone else on Medicare does. The penalty for not signing up by May 15 can be stiff.

According to Kaciuba, it amounts to 1 percent per month of the national average premium, which is $32.20, and is tacked onto Part D coverage for as long as the person has it.

Kaciuba encourages people to enroll in a plan even if they don’t take medications, because eventually they will.

Rutan explained that Medicare Part A is an entitlement program that everybody gets, and Part B, which amounts to $88.50 a month, comes out of Social Security checks, but Part D you have to shop for.

“It’s up to you,” she said. “Some policies cover a lot of things, some just a few. It depends on how much you want to put out for premiums.”

She explained that Medicare Advantage programs are not free and you cannot go to any doctor. “Even with a PPO, you will pay,” she said, adding, “Part D will help people who don’t have any prescription drug coverage now, but you have to do the research.”