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Director's Message

Medicare Changes 2008: Take A Look! December 2008

Medicare Changes: Take a Look!

November 15 to December 31 is the Open Enrollment period for Medicare. This is the time when you can make changes in your coverage. You have probably been getting mail for the past few weeks, especially from the Prescription Drug Plans. Read the literature carefully for any changes in your plan that might lead you to changing plans (you have 52 to choose from!):

· Cost—

Premium- how much per month? Range is $16.70 to $130.20/mo.

Deductible—how much do you pay before Medicare pays anything? Range is $50-200.

Copayment/coinsurance—how much do you pay for each prescription? Is it a fixed amount (copay) or a percentage (coinsurance)? Are there tiers of drugs with different copays?

· Coverage—

Formulary—Are all your medications covered?

Do you need prior authorization for expensive or experimental drugs?

Are there quantity limits for drugs you use?

Do they require “step therapy”-where you have to fail using a less expensive drug before you can have a more expensive one?

Is there a coverage gap (“donut hole”)?

· Convenience—

Is your pharmacy included?

Is mail order an option?

· Have you been satisfied with customer service?

If you want to compare your plan with others, go to www.medicare.gov and follow the prompts to comparing plans. You will need all the details of your current medications, your zip code and preferred pharmacy. Plans are also listed in Medicare and You 2009. If you need help, make an appointment with a SHIP counselor by calling 609-924-2098.

People who are eligible should be enrolled with PAAD or Senior Gold. 2009 income limits are $24,432 single and $29,956 married for PAAD, and $34,434/39,956 for Senior Gold. PAAD pays premiums, deductibles and part of copays, so participants will pay $7 brand/$6 generic maximum. Senior Gold participants will pay premiums, a $15 copay and 50% of the cost of the prescription. There is some coverage during the deductible and “donut hole” periods. PAAD participants MUST enroll in a plan which is under the benchmark of $30.99 per month or you will have to pay the premiums! Senior Gold participants must enroll in a plan under the benchmark or you will lose your coverage for next year!

If you have chosen not to have prescription coverage, the penalty continues to accumulate. You might want to reconsider your decision at this time (the penalty is 1% per month of the national base premium since May 2006) before it goes higher.

If you have had “creditable” coverage from an employee retirement plan, read the mailing you got in November and be sure the plan is still creditable (this information may be hard to find). Several employer plans are dropping prescription coverage for retirees as a cost-saving measure. You will not be penalized, but should enroll in a plan. You should not enroll in a Medicare drug plan if you are covered by an employer plan or Medicare Advantage plan that includes creditable coverage.

If you need assistance or information about prescription drug assistance programs, speak to a PSRC social service staff person.

Susan W. Hoskins LCSW