Medicare Part D takes effect Jan. 1

Beginning Jan. 1, Medicare Part D will offer prescription drug coverage to anyone eligible for Medicare. That, says Dorothy Knowles, executive director of the Southwest Missouri Office on Aging, is where the confusion begins.

“The key word is ‘everyone,’” she said. “It doesn’t matter if you’re low income or if you make $10 million. If you’re on Medicare, you qualify.”

Senior citizens eligible for the coverage also are overwhelmed by the number of options available to them under Part D and the complex process for signing up, said Andrea Croley, co-owner of Croley Insurance and Financial in Springfield.

“There’s so much confusion and so much information out there,” she said. “There was very little time to get this all out to seniors, and they didn’t make it simple.”

Enrollment for Part D began Nov. 15, and individuals must sign up by May 15 to avoid late fees. For coverage to start at the beginning of 2006, individuals must sign up by Jan. 1. Individuals can opt to change their plans once each year.

Beginning in 2007, the window to sign up will be between Nov. 15 and Jan. 1.

The yearly cost of prescription drugs determines where an individual falls in the coverage groups:

• All drug costs that are less than $250 per year must be paid out-of pocket.

• When costs fall between $250 and $2,250 per year, Part D covers 75 percent.

• Once costs surpass the $2,250 mark, an individual must pay all additional expenses out-of-pocket.

• If out-of-pocket expenses reach $3,600, and total drug costs reach $5,100, Part D then covers 95 percent of the cost.

People with low incomes or limited resources could be eligible for extra benefits, but the average person is expected to save about 50 percent in drug costs.

For individuals who fall into the “coverage gap” – those who spend between $2,250 and $5,100 – there are some discounted drug prices available through some pharmacies, Knowles said. Other Medicare coverage is available for them, as well, but at a higher premium.

Monthly premiums for Part D coverage will vary from $10 to $60, depending on the plan an individual chooses. Each plan comes with a formulary, or list of approved drugs. Plans with higher premiums include longer lists of drugs that are covered.

Croley suggests putting together a list of the drugs an individual takes before seeking out different plans.

“They have to be very careful with the formulary,” she said. “If they’re taking a lot of medications, be cautious to buy a plan that they’re sure is going to cover the medications that they’re taking.”

Armed with a list of their medications, individuals then can enlist the help of insurance providers or the Internet to choose an appropriate plan.

Medicare offers “Find a Plan” on its Web site, www.medicare.gov, that gives a step-by-step tool for picking a plan. But, not everyone is Internet savvy, Knowles said.

“It’s real easy for someone that knows how to use the Internet to find out for themselves – “Find a Plan” is very user-friendly,” she said. “But if you don’t know how to use a computer, that doesn’t help.”

Individuals who prefer to meet with someone to choose a plan have plenty of opportunities to do so before the end of the year.

The Southwest Missouri Office on Aging is scheduling appointments with senior citizens, as are most local insurance companies that offer Part D coverage.

For instance, Croley Insurance and Financial is hosting an informational meeting 9–11 a.m. Dec. 2 at the Cox Meyer Center, Ozark Room.