CAPITOL HILL REPORT CAPITOL HILL REPORT By Congressman Bill Delahunt
Given the widespread concern and interest in the new Medicare Part D benefit, my office has sponsored a number of Medicare Prescription Drug forums throughout the 10th District over the past year. To give you an idea of the interest, at the forum we held in Sandwich this past winter, over 40 people trekked through snow and slushy roads to attend, a remarkable turnout.
For many, navigating the snow and ice to get there was a lot easier than navigating the confusing rules and multiple plans under this new program. At the end of the forum, I asked one simple question: “How many of you think this program needs a second opinion?” Virtually everyone in the room raised their hand. This has been the nearly universal response at each of our Medicare forums throughout the Cape and Islands.
While several proposals have been floated to simplify and improve the Part D benefit, the political dynamics this year may complicate our efforts to reform this program Given these political realities, it is important that we do all we can to help seniors negotiate the options and develop a plan that works for them. Fortunately we have SHINE to help us.
SHINE is a joint federal-state initiative that provides free assistance and guidance to seniors who need help understanding their insurance options. I have been a strong supporter of the SHINE program, and in recent months have called on Sandra Cortese of Pocasset, the SHINE counselor for the Bourne Council on Aging to speak at my forums. Last year, Sandi was my delegate to the 2005 White House Conference on Aging.
The SHINE program has done an outstanding job concerning Medicare Part D. I want to share with you some helpful advice that Sandi and other SHINE volunteers have provided to seniors at our forums.
1. Consider applying to the Massachusetts Prescription Advantage Plan. It has no premium and assists with deductibles, co-pays and the infamous “doughnut hole.” The current deadline for enrollment in Prescription Advantage has just passed, but there will opportunities in the future.
2. You may be eligible for a low-income subsidy. Fill out an application for the low-income subsidy with the local Social Security office if you have not done so already. (Whether you turn out to be eligible or not, the state’s Prescription Advantage plan will require you to take this step.);
3. Make sure the plan you choose will cover your medications;
4. If multiple plans cover the medications you take, look for the one that has the best premium and lowest co-payments;
5. Make sure the pharmacy you wish to use takes the plan. (Most pharmacies in Massachusetts take all plans.)
Some plans will want you to start with a generic or lower priced drug than you may already be taking (represented by an asterisk next to the listed price on the www.medicare.gov site and referred to as “step therapy.”). They will require that the doctor contact them to indicate a certain prescribed drug is the only one that will be therapeutic.
To avoid the penalty for failing to enroll in a plan by May 15, those seniors who take few or no drugs may want to enroll in one of the least expensive plans for $7.32 a month, with $250 deductible or for $13.92 with no deductible just to assure coverage for the occasional prescriptions such as antibiotics.
Individual assistance is available from your local outreach worker or SHINE counselor by calling your local COA or SHINE at 508-394-9326 or 1-800-334-9999..
Other helpful numbers:
Prescription Advantage: 1-800-243-4636
MassMedLine: 1-800-633-1617
Medicare: 1-800-Medicare
And my own office: 1-800-870-2626 (toll free)
Again, I’m grateful for Sandi’s assistance and help in speaking at our forums over the last several months. We’re very fortunate in southeastern Massachusetts to have such dedicated volunteers looking out for the seniors in our community. I encourage you to take the time to talk with these folks and let them help you with this important decision.