CAPITOL HILL REPORT

Medicare ‘Reform’—Tread Carefully

By Congressman Bill Delahunt

Starting January 1, Medicare began offering prescription drug coverage through new private drug plans and through Medicare managed care plans (now called “Medicare Advantage” plans).

I opposed the law that created this program because the drug benefit is inadequate, overly complex and was set up to maximize profits for the pharmaceutical and HMO companies rather than maximizing help to Medicare beneficiaries.

That being said, people need to be armed with the information necessary to make the best decision about whether to join and, if so, which plan best meets their needs.

Whether you are a senior, a person with a disability or someone trying to help a parent or friend, I encourage you to carefully research the available options before making a choice. Most people have until May 15 sign up for a plan before late enrollment penalties apply, so take your time, check your facts and know your options.

I've tried to gather some basic information to help you face these complicated choices. I hope it is helpful.

Whether to enroll in a Medicare prescription drug plan depends upon what kind of coverage, if any, you have today.

Important Considerations

If you have prescription drug coverage through a retiree plan:

Check with your former employer about your options before doing anything. If you are happy with your employer coverage, and it is continuing, you should not need to do anything.

Caution: if you drop your employer or union health coverage, you may not be able to rejoin it later.

Caution: To receive free premiums, you will need to pick a plan with average or below average premiums. If you fail to choose a plan, you will be automatically assigned to a plan. You will be able to change plans monthly if need be.

If you are currently enrolled in a Medicare managed Care plan (such as Kaiser, etc.):

Your plan should already have sent you information about your options this month. If you want to stay with your current plan and it offers a prescription drug plan, you may enroll.

If you do not want to remain in that plan, you may either enroll in a different Medicare Managed Care plan or return to traditional Medicare and select a private drug plan.

If you currently do not have prescription drug coverage:

Evaluate your needs and investigate your options. But, remember, monthly premiums will be higher if you do not enroll by May 15. You will also want to determine if you are eligible for limited income assistance.

Resources

Organizations that can help:

• Medicare: 1-800-MEDICARE (1-800-633-4227)
• Social Security Administration: 1-800-772-1213

Have the following information with you when you call:

• Medicare identification number (on your Medicare card)
• Drugs you currently take, the dosage and what you pay for them
• Your refill schedule and preferred method of receiving prescriptions (at the pharmacy or via mail-order)
• Your annual income and a basic accounting of your personal assets in case you qualify for low-income assistance

Extra assistance for people with limited incomes:

• Help with paying for Medicare drug plans is available for people with limited incomes.
  You may qualify for this assistance if:
  • Your 2005 income is less than $14,356 for an individual / $19,245 for couples and you have limited assets.
  • If you think you should be in this category, call the Social Security Administration at 1-800-772-1213 or visit them online at http://www.socialsecurity.gov/ for more information.

Informational Web Sites:

• Medicare: http://www.medicare.gov/
• Social Security: http://www.ssa.gov/prescriptionhelp

Good luck!