AAMC Magazine

Summer 2006

A Senior Moment

Advice for Seniors Enrolling in the Medicare Prescription Drug Plan

picture of a senior couple taking prescription medication
If you need help enrolling in the medicare prescription drug plan, the following agencies are available to assist you.

County Departments of Aging:

Anne Arundel 410-222-4964
Baltimore 410-887-2108
Caroline, Kent and
Talbot 410-758-6500
Calvert 410-535-4606
Howard 410-313-6410
Prince George's 301-265-8450
Queen Anne's 410-758-0848

The new Medicare Prescription Drug Plan (Part D) that rolled out last fall is helping millions of seniors save money on their prescription drugs, but the program has some potential snags that can trip you up if you’re not careful.

The basic plan costs about $32 a month. There is a $250 annual deductible, then you pay 25 percent of your yearly drug costs, until your total drug costs (including the 75 percent paid by Medicare), reach $2,250. You pay 100 percent of your next $2,850 in drug costs. This is commonly known as the “donut hole.” Once your out-ofpocket costs reach $3,600, then Medicare begins picking up 95 percent. However, there are many plans with many different insurance companies, each with their own options, so you need to shop for the best plan for your needs.

Larry Ulvilla, president of Insurance Solutions who advises the hospital on insurance issues, offers some tips about choosing a drug plan.

Mr. Ulvila said, “In Maryland, there are more than 40 plans with 20 insurance companies. They all offer different packages, so it’s important to find the one that’s most beneficial to you,” he said. “Once you have selected a plan and enrolled, it’s also important to stay abreast of any changes to your plan, which is inevitable, and to any changes in your prescriptions, which may affect your costs. Watch for prescription drugs that are released for over the counter (OTC) sales. Drugs, such as Claritin, are much cheaper as an OTC than as a prescription medication, and you may be paying more than you need.” But you may find that you’re better off using the prescription drug, because most insurance companies will not reimburse for OTCs, he said.

Medicare’s website, www.medicare.gov provides information on all of the plans available in Maryland. This site also provides interactive tools to help you find the plan that is best for you. The county Department of Aging and the Senior Health Insurance Program (SHIP) (see contact information at right) provide education and assistance with plan selection.

Medicare Part D Seminar

Larry Ulvila, in conjunction with the AAMC Community Health and Wellness, will hold a free Medicare Part D seminar 6-7:30 p.m., Tuesday, September 26 in the Sajak Pavilion. Call askAAMC at 443-481-4000 to register by phone or register online.

Mr. Ulvila offered these tips:

The prescription drug plan is available for anyone with Medicare A and/or B, regardless of income. Those in lower income brackets can apply to the Social Security Administration for extra help to help pay monthly premiums.
If you are eligible for the Medicare Prescription Drug Plan, do not have creditable coverage as defined by Medicare, and did not enroll by May 15, 2006, you will be charged 1 percent more per month for every month you do not enroll. The next opportunity for enrollment is November 15-December 31.
If you have creditable coverage as defined by Medicare, you may wish to continue with that coverage, and do not need to enroll in a Medicare Prescription Drug Plan. If your creditable coverage ends, however, you must enroll in a Medicare Prescription Drug Plan within 62 days to avoid the 1 percent per month premium penalty.
If you are going to enlist help to get enrolled in a plan, make sure to prepare a list of your prescription drugs and dosages so that you can determine which plan formulary best fits your needs.
If you are considering a Medicare Advantage Plan (like an HMO or PPO), which provides comprehensive medical insurance (medical, dental and drugs), make certain that the Advantage Plan has better coverage than any retirement insurance you already may have. Once you enroll in an Advantage Plan, your retirement insurance is automatically cancelled.
If you already have a retirement drug plan, make sure you weigh all the options before enrolling. Different plans cover different drugs at different costs, so you really do need to do your homework.
There is an appeals process in the event a drug you need is not covered or if you are prescribed more of a drug that your plan will allow.

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