Drug Coverage Made Simple
JIM: Some of my friends and I are so confused about the new Medicare drug
prescription program that we don’t know where to start. We’ve received
dozens of different offers in the mail, and they are all so difficult to
understand. How do we choose the right plan to meet my needs, and what if
we make a mistake and choose the wrong plan? WORRIED IN WOOSTER
WORRIED: Yes, it is confusing, isn’t it? But, as my father always
says, “don’t make a mountain out of a molehill.” And he’s right
Medicare Prescription Drug, Improvement, and Modernization Act of 2003
(Public Law 108-173) is the largest expansion of the Medicare program
since 1965. Commonly known as the Medicare Modernization Act, or MMA, it
is scheduled to begin offering more than 40 million seniors and disabled
Americans access to prescription drug coverage beginning in January 2006.
The text alone is more than 400 pages which should give some idea of the
complexity of the new law.
according to Peter Ashkenaz, spokesman for the Centers for Medicare and
Medicaid Services (CMS) in Washington, D.C., the decision is not as
difficult as it might seem. “Don’t make it tougher than it really is,”
says Ashkenaz. “Just make a list beforehand of what is most important to
you such as premium cost, deductible, and coverage (which drugs are
covered). Then, sit down at the table with an open mind, with the
information spread out in front of you, organize it in terms of what is
most important to you according to your list, and discard the rest.”
is entirely voluntary, but if you sign up after May 15, 2006, you will pay
a penalty. Some people may have already signed up under the early “deadline”
(November 15-December 31) and will begin coverage effective January 1,
2006, and many people may not choose to sign up at all if they already
have other drug coverage that is better than Medicare’s coverage (e.g.
benefits from a current or former employer or union, VA, Tricare, Medicare
Advantage). If you later lose this coverage, you will not pay a penalty if
you change to a Medicare drug program within 63 days.
don’t worry if you think you have made a wrong choice because you have
the option to change to a different plan every year between November
15-December 31 without any penalty whatsoever. In fact, if you use few or
no drugs now, you might want to start low to protect your options and
avoid any later penalties and increase your coverage as your needs change
in the future.”
the meantime, I suggest that you sit down with family and friends –
perhaps an RSVP* volunteer - to help guide you through the different
choices. But don’t panic - you still have until May 15, 2006, to make a
selection and, while the choices are many, once you have reduced them down
to what you need, making an educated decision is easier than you think. It
really comes down to this: does the plan cover your specific prescription
medications and how much does it cost.
you have access to a computer, you can refer to www.medicare.gov
for help or you can call 1-800-MEDICARE if you have a specific question.
Editor's Note: RSVP (Retired Senior Volunteer Program) has many members that are
participating in the CMS MedicareRx Volunteer Initiative, a national volunteer corps of individuals committed to providing personalized assistance to people with Medicare who need help understanding and joining a prescription drug plan. CMS has partnered with the Web site VolunteerMatch.org to recruit, train and deploy
Evans is a 38-year veteran of the health and fitness industry and a
nationally recognized consultant on fitness for seniors. He is also host
of the popular radio talk show “Forever Young” on San Diego’s KCBQ
1170 AM (KCBQ.com).
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