Medicare & Who?

Michelle Swafford

Monday, Oct. 31, 2005 | 8:38 a.m.

Las Vegas residents Bob Fabbri, Charles Coutteau and Lorna Taylor are confused about the new Medicare drug benefit that will begin in January.

They're far from alone in their confusion about whether beneficiaries should sign up for one of the 44 Medicare Part D drug plans that will be available in Nevada, how to enroll in one and what the costs will be.

"I'm very confused. I've been to two or three (Medicare meetings)," Cotteau said after a community Medicare meeting. "The one thing that makes me a little nervous is once you get into a program you're in it for a year."

Medicare beneficiaries -- people age 65 and older and people younger than 65 with permanent disabilities or end-stage renal disease -- will be able to sign up for a drug plan from Nov. 15 to May 15, 2006.

That will be the first Bob Fabbri and about 70,000 other Nevadans will have access to prescription drug coverage.

Fabbri said he is hoping that a Part D plan will save him some money on the $105 he spends each month on prescriptions.

More than 42 million Americans received the "Medicare & You" handbook designed to explain the Part D plans and whether people should sign up.

Fabbri said the booklet is confusing and said he worries about what will happen in the long run.

Confusion isn't the only sentiment being expressed by Medicare beneficiaries.

"Congress did a half-ass job," Medicare beneficiary Kent Weaver said. "I didn't realize it was as involved as it was -- enrollment periods, penalties."

He said he is waiting to find out whether his wife's health plan will continue to cover his prescriptions or whether he'll need to sign up for a Part D plan.

Signing up for a Part D plan is voluntary, but Medicare beneficiaries who sign up after May 15 could face higher premiums, especially those who do not have other drug coverage that the Centers for Medicare & Medicaid Services (CMS) has deemed "creditable" -- meaning it is at least as good as Medicare's basic requirements.

Employers, unions, the military and private health plans that provide drug coverage to Medicare beneficiaries are required to send a letter by Nov. 15 stating whether their plans are "creditable" and whether they will continue that drug coverage. Employers and other private groups have a right to drop the coverage for Medicare beneficiaries, but will receive tax breaks if they maintain their coverage.

Once people abandon their current prescription coverage they cannot go back to them if they decide they don't like the Part D plan. The beneficiaries also may lose their private health coverage if they sign up for a Part D plan when they have prescription coverage, said Marilyn Wills, director of the Nevada State Health Insurance Assistance Program -- also known as the SHIP office.

CMS is encouraging beneficiaries to sign up for a drug plan using the www.medicare.gov Web site, which enables people to list their drugs, dosages and pharmacy preferences. The Web site then lists the Medicare Part D drug plans that would best meet their needs.

Beneficiaries also can sign up directly with the Part D plan providers, which are sending out mailings and making telephone calls.

CMS has said that someone else can fill out the information on behalf of Medicare beneficiaries and the Nevada State Health Insurance Assistance Program (SHIP) is assisting people who do not have computers or family members to assist them in enrolling in a Part D plan.

Lorna Taylor has attended several of the community Medicare forums to better understand the Part D plans that will affect her mother, husband and friends.

While she is not eligible for Medicare yet, she is trying to gain as much knowledge as she can to help her loved ones.

"I'm more confused than ever," she said. "I regret that I didn't go on to get my Ph.D. to understand the Medicare prescription drug coverage. The more I learn about it, the more I need to know."

One of the reasons Medicare beneficiaries are confused is because the plans vary dramatically. Nevada premiums range from $6.42 to $64.63 a month and are billed to the beneficiaries, not taken out of their Social Security checks.

Medicare beneficiaries can enroll in a Medicare Advantage plan -- a private Medicare plan that has more benefits than traditional Medicare -- for prescription drug coverage and health coverage with no monthly premiums, but they could be restricted to seeking care from a list of approved doctors and hospitals.

All Part D plans must offer a minimum of 95 percent drug coverage after beneficiaries pay up to $3,600 annually in out-of-pocket costs, which does not include their monthly premiums. Some plans require beneficiaries to pay less than others.

Out-of-pocket costs are tracked on Medicare beneficiaries' Medicare cards and must be met individually, meaning each person in a married couple will be tracked separately.

"Don't get stuck on the premiums. The thing you should get stuck on is it covering my medications and can I use it where I want to use it," Wills said of the Part D plans.

Michelle Swafford can be reached at 259-2326 or at swafford@lasvegassun.com.