‘Medicare Express’ road show to tour Nevada

Friday, July 22, 2005 | 9:36 a.m.

CARSON CITY -- A road show kicked off Thursday to tell an estimated 292,000 Medicare recipients in Nevada about the benefits and costs of the federal government's new prescription drug program.

Federal representatives will visit 40 cities, towns and communities in Nevada on the "Medicare Express" touting the plan approved by Congress and signed by President Bush in 2003.

But some of the answers for senior citizens won't come until October when the various companies, HMOs and PPOs reveal their programs on what drugs and other benefits they will offer.

About 75 people were present at the Carson Senior Center on Thursday when Peter Bauer of the Centers for Medicare and Medicaid Services made his presentation.

To join the program, Medicare recipients will pay an estimated $37 a month premium with a $250 deductible. That means the senior will pay the premium and the first $250 in drug costs.

After that the enrollee will pay 25 percent of the drug costs from an annual $250 to $2,250 drug bill. But then there's what is being called the "donut hole." A senior in the program will pay 100 percent of the cost of drugs from an annual $2,250 to $5,100.

After $3,600 in out-of-pocket costs, Medicare pays about 95 percent of the drug cost.

Medicare recipients will be able to sign up from Nov. 15 to May 15, 2006. The program starts Jan. 1, 2006. Those who sign up after May 15, 2006, will be penalized one percent a month. Otherwise if a person signs up in June 2006, a one percent cost will be added to the $37 monthly payment.

Bauer said he "can't tell where and what" prescription drug programs will be available until October when the companies in the program are revealed. And these companies may offer different benefits.

Bauer stressed that the program would be available to citizens statewide, even in the smallest communities.

Low-income citizens, he said, could be eligible for help from the Social Security Administration in paying the premiums, he said.

There are an estimated 16,000 Nevadans enrolled in both Medicare and the state-operated Medicaid program for low income seniors.

Chuck Duarte, administrator of the state Health Care Financing and Policy Administration, said those in Medicaid will be transferred to the new prescription drug program.

Those 16,000 will not have to pay the $37 a month premium. In a program called Clawback, the state will pay the federal government $14.4 million for the remaining six months in fiscal year 2006 and $34.7 million in fiscal 2007.

Duarte said this would still save the state $4 million over the biennium on what it is spending on drugs for Medicaid recipients. But he said recipients would be responsible for meeting the co-pays under the federal program.

In addition, the state runs the Senior RX program for about 9,000 elderly who make less than $23,000 a year. They pay $10 for a generic drug and $25 for a brand named prescription.

State Human Resources Director Mike Willden said the state intends to "wrap around" Senior RX with the Medicare drug program. He said about 8,000 of the 9,000 people in Senior RX will qualify for the Medicare program.

A plan is being developed so that the senior who goes into the Medicare program will not be any worse off than in Senior RX. Willden said that may mean the state paying the monthly premiums, some of the co-pays and picking up the costs in the so-called "donut hole" when Medicare does not pay any of the annual drug costs from $2,250 to $5,100.

Some states, Willden said, are canceling their Senior RX programs and forcing the elderly to enroll in Part D, the drug component of Medicare.

Seniors who want more information on the prescription drug program can call toll free (877) 888-3165 and receive a free Medicare gift (a pot holder) while the supply lasts.