Las Vegas Sun

March 29, 2024

Seniors get tips on new Medicare options coming next year

Medicare recipients will have more health plan choices and expanded health care coverage next year, but evaluating the options could be confusing.

That's why Centers for Medicare and Medicaid Services officials met last week with seniors and health care professionals to explain the changes that take effect in 2006 and what must be done in the interim.

Seniors who are insured through traditional fee-for-service Medicare can retain that coverage or opt for private Medicare plans in the form of a health maintenance organization or a preferred provider organization.

The private plans will offer more benefits than traditional Medicare coverage such as more prescription drug coverage and vision and dental coverage. The premiums and out-of-pocket costs will vary by health plan.

Health plans receive payments to administer the private Medicare plans and those payments have increased, which is one of the reasons interest in offering private plans has increased, said David Sayen, associate regional administrator of the Centers for Medicare and Medicaid Services Region IX.

In Southern Nevada, Sierra Health Services Inc. -- operated as Senior Dimensions, and PacifiCare Health Systems LLC -- operated as Secure Horizons -- currently offer private Medicare managed-care plans and will offer additional plans in 2006.

Sierra Health has applied with the Centers for Medicare and Medicaid Services to offer a statewide PPO in Nevada and similar plans in parts of Arizona and Utah. PacifiCare has applied to offer private fee-for-service plans, which will be modeled after a combination of traditional Medicare coverage and Medigap coverage that would be available at a lower cost.

Expanded health plan choices isn't the only major change for Medicare recipients. Seniors on traditional fee-for-service will also need to sign up for a prescription drug plan, called Medicare Part D coverage.

The prescription coverage replaces the drug discount cards that were implemented in 2004. Medicare beneficiaries can begin signing up for prescription drug coverage Nov. 15, which entitles them to insurance for prescriptions in exchange for monthly premiums, a co-payment or coinsurance (a percent of the total cost paid by the patient) for each prescription filled and a deductible.

An example of a prescription drug plan would require a $35 monthly premium and a $250 deductible. Policyholders would pay 25 percent of their drug costs from $250 to $2,250 and Medicare would pay the rest. Above $2,250, Medicare recipients are responsible for all of their drug costs until they reach $5,100, or $3,600 in out-of-pocket costs. Then Medicare would pay 95 percent of their drug costs.

Few people will be affected by the coverage gap when Medicare beneficiaries are responsible for all of their drug costs, Mark Manfredi, health insurance specialist of the Center for Medicare and Medicaid Services Region IX in San Francisco.

The effective date is Jan. 1 for people who sign up by the end of December. People who sign up after Jan. 1, would be able to use their coverage in the month following the day they sign up.

There will likely be several prescription drug plans to choose from, although the Centers for Medicare and Medicaid Services has not approved any plan providers yet. Each plan will have a different list of covered drugs -- at least one brand name and one generic drug will be listed for drugs that are covered -- and the co-payments and other costs may differ, Manfredi said.

"Figure out what drugs you're on now and what you might be on in the future," he said.

Medicare beneficiaries need to sign up for a prescription drug plan by May 15. Those who do not sign up for prescription coverage and do not have comparable coverage through another health plan would have to pay a 1 percent higher premium for each month after May 15.

Letters will be mailed to people to explain whether their current drug coverage is comparable to the Medicare plans. People on private Medicare plans such as Senior Dimensions and Secure Horizons do not need to sign up for a prescription drug plan.

There are a few exceptions to the prescription drug plan deadline. Medicare beneficiaries who move out of their plan's service area, move in or out of a long-term care facility or involuntarily lose coverage can enroll beyond May 15, Manfredi said.

Medicare beneficiaries who are also on Medicaid and earn less than 100 percent of the federal poverty guidelines -- $9,570 for individuals and $12,830 for a family of two in 2005 -- should apply for assistance with their Medicare drug plan premiums and some of their drug costs through the Social Security Administration. Financial help may also be available for other Medicare beneficiaries who meet a different set of poverty and asset guidelines may be eligible for a lesser amount of assistance, said Leslie Walker, regional communications director of the Social Security Administration's Region IX.

Social Security assistance forms can be filled out on the Internet at www.socialsecuirty.gov beginning July 1 or by mail or telephone. Prior to July, people who think they may qualify for financial assistance can determine their eligibility on the Social Security Administration's Web site, Walker said.

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