Tracy Bishop, owner of Deans Pharmacy of Centre, addressed the new plan during the October meeting of the Cherokee County Chapter of the American Association of Retired Persons. Bishop, who has spoken before several groups on this subject, has made no secret that he has had reservations about the plan from the beginning.
This bill was pushed by President Bush as a campaign promise to senior citizens to provide some kind of relief for the high cost of drugs, said Bishop. His proposal was that we add another component to Medicare to start paying for drugs. Medicare Part A takes care of you when you are in the hospital or doctors office, you have Medicare Part B to take care of home health equipment, home health nurses, then here comes Medicare Part D. President Bush had to sign the bill into law in December 2003. We have come a long way since December 2003. The first part of the act said that they were going to issue discount cards to senior citizens who were eligible for Medicare. You probably have a discount card of some type from a lot of different companies offering them. They help give you some relief on the cost of prescriptions, but then again, it was only a discount. They didnt pay every penny of it. Some people were able to get transitional assistance through these discount cards. Transitional assistance is based on your income. When you qualify for transitional assistance, you receive $600 in 2004 and another $600 in 2005. When you present your card to your pharmacist, then it is billed online and the government pays up to $600 of your expenses.
These discount plans will remain in effect until the senior citizens sign up for the Medicare Part D plan which begins this month.
This month is when you are going to start getting some information, said Bishop. This month is when the insurance companies that are going to administer Medicare D are going to start signing you up for the insurance. The government decided they couldnt do this by themselves. Medicare could not administer this plan by themselves, so they have allowed insurance companies that are already in drug coverage or some other type employer to start doing Medicare Part D. In Alabama, there are 16 that have been approved so far to provide you with Medicare Part D coverage. Medicare Part D is not limited to income. Anyone who is eligible for Medicare Part A is eligible for Medicare Part D. However, Medicare Part D is not a free program. You will have to pay on top of your Medicare premium which you already pay. Medicare premiums beginning in January are going up about $7.60. The Medicare Part D costs $35 per month. You will have to pay that every month for your Medicare Part A and B and Medicare Part D.
And this cost, Bishop said, is per individual, not per couple. The premiums will also include a $250 deductible which must be paid out of pocket.
We are already out over $100 per month just for the privilege of having Medicare Part D, said Bishop. Once you have spent $250 out-of- pocket, every prescription you get from then on will have a 25 percent co-pay. Medicare pays 75 percent of it for you up to the point where you reach $2,250 in total drug costs for true out-of-pocket expense. Once you reach that amount of money, then you go back and pay 100 percent. If you spend up to $3,500, once you spend that amount, Medicare starts again paying 100 percent of the drug cost. So there is a gap between $2,250 and $3,500. You have no coverage at all. The plan itself has caused a lot of confusion. It continues to cause a lot of confusion and as I told Congressman Mike Rogers who was here on Monday, I wish he could come spend a day in my store and answer your concerns like I do, because he doesnt realize what the law he voted for and signed into law has actually cost. It causes you problems in understanding and trying to make a wise decision on which insurance company to choose and it causes me problems because Ive got to be able to advise you on what plan to take.
Packets from the various drug companies have already been mailed out, Bishop said.
In this packet, they explain what Medicare D is, how it is going to affect you and they also explain to you in this packet of information that if your income is a certain level, you can qualify for help from SSI on the premium cost of Medicare Part D, said Bishop. There is a form that was included in this packet that you are to fill out and on that form, they want to know how much money you make, how much your estimated drug costs are year or per month.
Open enrollment, Bishop said, is Nov. 16 of this year to May 15 of next year. Those who do not sign up prior to May 15 face a 1 percent penalty of the premium for every month he/she are eligible for insurance. Exceptions to this rule include those who have their plans abruptly cancelled for various reasons. The plan will begin the first day of the following month in which the recipient signs up. After this year, the annual enrollment period will be Nov. 15 through Dec. 31.
Bishop urged seniors not to be too hasty in picking a plan since the insurance companies are not required to cover the same medications.
The first thing you are going to need to do is go to wherever you get your medication is filled and ask for a printout so that you can know, up to this point in the game, how much money you spend on your medication, said Bishop. That way when you start getting all of these insurance companies sending you letters wanting you to buy their plan, you are getting to look with some type of help with what you take and what they cover.
That information on what the drug companies will cover wont be available until Nov. 13, Bishop said.
I spend a lot of my day answering questions about health care, which is fine, but I cant tell you today which insurance plan is better, said Bishop. It is going to be on an individual basis. It is not going to be one insurance company doing it all.
Im going to close by leaving it open, because we are not finished with this yet, said Bishop. Im trying to let you know that I am available to help you, but there are still a lot of things up in the air. Theres still a lot of answers I dont know yet. Until we see the plan, the drugs they are going to cover, theres not one particular plan that stands out among these insurance companies which would be the best ones to take.