Medicare part D begins
By Scott Nicholson
Changes to Medicare enrollment begin on Nov. 15 and Medicare recipients will be able to choose from a number of plans.
While some of the plans can seem complex, the North Carolina Department of Insurance is available to offer advice. The department’s Seniors’ Health Insurance Information Program (SHIIP) is the lead agency in offering enrollment assistance in the state.
Locally, the Project on Aging is serving as the SHIIP contact, with Sherry Harmon as coordinator. She can be contacted at 265-8090.
Roberta Hamby, SHIIP’s education coordinator, said volunteers have been trained to help people understand the changes and procedures, but said there is a good bit of confusion among recipients who have to select a plan.
“The principal concerns (in choosing a plan) are the prescriptions the person is currently taking and if they are covered by that plan,” she said. “There’s also the cost factor, and whether you want a standard deductible or not.”
N.C. insurance commissioner Jim Long said in a statement that the Medicare D changes were “the largest and possibly most confusing change to Medicare since it first began in 1965.” SHIIP relies on volunteers who have received training on the Medicare prescription drug plans and can provide counseling to recipients who are confused by the changes.
The state SHIIP office, which has a toll-free line at 1-800-443-9354, has received an average of 400 to 500 calls per week about the Medicare changes, which take effect in January.
In North Carolina, there are 16 approved companies that can offer the Prescription Drug Plans. These companies offer a total of 38 different plans, which is why some help may be needed in navigating the options. These are private companies that have been approved to provide the coverage.
Enrollment is recommended before Dec. 31 to prevent delays in coverage. May 15 is the deadline for enrolling, and a one-percent penalty may be incurred for every month of delay after that.
All Medicare recipients are eligible to enroll in the prescription drug plans. Each company offers different plans and features, with their own deductible and co-payment structures. Monthly premiums for the plans range from $20 to $68.
In making selections, recipients should look at the list of drugs on each company’s plan and compare them with their own prescription needs. The company’s policy on generic compared to brand-name drugs may make a difference. It’s also important to see if that company works with the preferred local pharmacy.
Ten of the plans offered in North Carolina are nationwide, which may make a difference for Medicare recipients who spend significant time in more than one state. Some plans are stand-alone insurance plans while others are administered through health maintenance organizations, preferred payer organizations and private for-fee services. SHIIP also offers a handbook called “Medicare and You 2006 Handbook” to help consumers make informed decisions.
The approved plans have basic minimal features, such as an initial $250 drug deductible per year. After a total prescription expense of $5,100 per year, Medicare pays about 95 percent while the beneficiary pays about five percent. However, Hamby said there are enhanced plans in which people can choose a no-deductible plan. Low-income people can receive additional assistance, and most MediGap plans require enrollment. More information is available at www.ncshiip.org or www.medicare.gov.
While enrollment is not mandatory, Hamby said those enrolling after Dec. 31 will lose Medicare drug benefits until they are enrolled. If enrolled late, the plan takes effect on the first of the following month.
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