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April 19-25, 2006

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John and Rita Casias

Courtesy Casias Family
Prescription for trouble: Even with long professional experience, John and Rita Casias needed help from many quarters to untangle the prescription mess.

Drug Race

Prescription-drug deadline looms for seniors

By Tami Casias


Everyone on Medicare must choose a prescription-drug plan by May 15 or face future monthly penalties. Hearing this, my live-in in-laws began to sift through the piles of information sent by the government and their insurance company.

At ages 81 and 79, John and Rita Casias are not strangers to paperwork and processes. John spent a career as a school principal while Rita worked in office administration. However, trudging through the many different prescription options can be overwhelming.

"They don't write things out the way we can understand," Rita says, thumbing through the thick tables of providers and formularies. "I think this was thrown together real fast. This should have been brought out months earlier so people would have time to figure out what they need and are entitled to."

Like most people over the age of 65, John and Rita receive Medicare Part A, which covers hospital costs. They have also elected to pay for one of the 10 supplemental Medicare Part B plans for costs not covered by Part A, such as doctor and emergency room visits.

Many different companies sell Part B plans, labeled "A" through "J." Although sold at surprisingly different prices, each plan C by law is, for example, exactly the same as plan C at any other company.

John and Rita have already chosen plan F, because it is supposed to pay for hospital costs not covered under Medicare Part A, and it also includes a prescription-drug benefit. The plan works; Rita's out-of-pocket expense for a $350,000 open-heart surgery was zero. But with the government's new drug plan, they need to make sure their current coverage is right for them.

Despite her major surgery, Rita is healthy and active, and takes only one medication daily for blood pressure. While John is also healthy ("Very healthy," Rita interrupts), he takes six blood-pressure and cholesterol-related medicines, and has a monthly $1,300 injection for anemia.

Although Rita and John had read about informational prescription-drug meetings for seniors, they weren't convinced to attend.

"Some of these places talk to you and give you a basic, overall picture," Rita says, "but can't give you one-on-one answers to specific questions. You're thinking of your own problems and want to know what you're up against."

Instead, they took their questions directly to their insurance agent. He explained their choices and gave me a much-needed tutorial. Rita and John were given 48 options to choose from ranging in price from $5.41 to $50.91 per month.

"Not all plans are the same," insurance agent Dean Zeller warns. "Most of them have decent formulary lists of accepted drugs, based on the top 100 drugs seniors are taking. Not all of the drugs are covered under all plans."

Some cover only generic, non-brand-name prescription drugs. There is also something seniors know of as "the gap."

The gap occurs when people hit the annual allowable benefit limit of around $2,250, according to Zeller. At this point, 99 percent of all the plans disappear and the participant pays the maximum for drugs up to around $3,600. The government comes back in with very low priced medications through the end of the calendar year. On Jan. 1, the plan starts over at the beginning.

A select few plans, like the $50.91 plan offered by Humana, close the gap by keeping the drugs priced at the low rate throughout the entire year with both generic and brand-name drugs. Pacific Care and Blue Cross have similar gap-filling plans for generics.

John and Rita volunteered a list of their medications with dosages to their agent; it's discriminatory for him to ask to see this. The agent input their information into the Medicare.gov website to create a comparison between their current drug coverage and others, and came up with a new plan that will save them more than $1,000 this year. "One thing the government got right was Medicare.gov," Zeller says. "It's a great website."

Any plan picked now can be changed once before May 15, then once again between Nov. 15 and Jan. 1. What may be misunderstood is that every American over 65 is supposed to pick a plan by May 15. The penalty is 1 percent of an average figure of around $32.40, and is assessed each month until you pick a plan.

"Someone might say, 'I don't need to pick a plan--I'm not using any drugs,'" Zeller says. "Let's assume you need to buy the plan in 18 months. The penalty would be about $5.83 tagged on to whatever plan you ultimately choose, per month, for the rest of your life."

Zeller recommends buying at least the $5.41 plan to reserve a space in the program. It's there if you need it and not a big hit if you don't.

Seniors weren't the only ones scrambling for prescription-drug information when the plan was announced Nov. 15."John and Rita were ahead of the curve," Zeller says. "They called me in December. I couldn't get back to them soon enough. I didn't have enough information."

Carriers didn't have enough original material to go around. The first informational packets Zeller received were copies. "No carrier or government organization could ramp up for this. This is like Hurricane Katrina," Zeller says. "Humana took in 2 million applications in one month."

I call my own parents, curious to discover which plan they have picked. "I got some information from the Internet," my dad says. "It was so confusing I threw it in the trash."

Typical.

In less than five minutes on Medicare.gov, I enrolled them in a prescription-drug plan that covered all of their medications.


May 15 is coming. To learn more, go to www.medicare.gov. You can apply or get extra help by calling Social Security at 1.800.772.1213.


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