Terry Savage of the Chicago Sun-Times wrote an article answering some of the questions he hears most frequently about Plan D. I found it quite useful, so I’m reposting it here for you:

Q. Is there an income limit to apply for Part D?

A. No, Medicare Part D is meant for everyone who is Medicare eligible. There are no income limits. But you are not automatically enrolled. You must sign up for Part D, by purchasing a plan offered through private companies.

Q. Then why did I hear about income limits?

A. The federal government provides assistance in paying the monthly Part D premium for people with low income and few assets. Contact the Social Security Administration to see whether you qualify for this federal “Extra Help” program.

The state of Illinois also has a program that assists low-income residents — without regard to assets. It’s called Illinois Cares Rx, and it coordinates and supplements the benefits received under approved Part D plans and the Extra Help program.

Under Illinois Cares Rx, everyone who is already enrolled in the two existing Illinois programs, SeniorCare or Circuit Breaker, will be enrolled in a Part D program offered by UnitedHealth Group or PacifiCare.

Separately, seniors also must apply for the federal Extra Help program through Social Security. Then the Illinois Cares Rx program will automatically coordinate both plans.

If you are not already covered by SeniorCare or Circuit Breaker and think you might qualify for the Illinois Cares Rx plan (with income below $21,218 for a single or $28,480 for a couple), you should call the Illinois Department on Aging (800) 252-8966.

Q. What is that penalty for signing up late?

A. If you sign up after May 15, you’ll pay an extra 1 percent of the national monthly average rate. For example, if you sign up in two years, your monthly premium, no matter which plan you choose, will be 24 percent higher.

Q. What if I’m currently Medicare-eligible, but still working and covered by my company for prescription drugs? Or what if I’m retired but still covered by a retiree plan?

A. You can maintain your current coverage as long as it is considered “creditable.” That is, the company or union must give you a certificate stating its coverage is at least as good as the Part D coverage. Look for this certification, and contact your company if you don’t receive it.

Q. What if I have a Medicare supplement that offers prescription drug coverage?

A. You’ve been paying for prescription drug coverage under supplement plans H, I and J. But the new Medicare Part D will in almost every case offer better coverage, especially because of the “catastrophic coverage” that goes far beyond the limitations of the supplement plans. Compare, and you’ll probably purchase Part D.

Q. What if I’m currently covered by the VA for my prescription drugs?

A. You can have both VA coverage and Part D coverage. But each prescription can be handled by only one of the providers, and you must choose which one.

If you decide to stay with the VA and not enroll in a Medicare Part D plan, you will not be penalized if you later change your mind and decide to enroll in a Medicare drug plan during the open enrollment period, which will run from Nov. 15 through Dec. 31 of each year.

Q. I’m confused about the “stand-alone” plans and the Medicare Advantage plans. What’s the difference?

A. Stand-alone plans are just that: They cover only prescription drugs. So you’ll still pay for Medicare, and probably a Medicare supplement. But the Medicare Advantage plan is like an HMO (Health Maintenance Organization) that combines all costs in one plan, including drugs.

The drawback is that you must use the physicians and hospitals and drug formularies (lists) approved by the plan.

From the Tuscon Citizen:

Oops. The government’s official handbook for explaining Medicare to beneficiaries contains an error about the new prescription drug benefit, which kicks in Jan. 1.

The 35 million handbooks are being shipped in waves. Some beneficiaries may get them this weekend.

Gary Karr, a spokesman for the Centers for Medicare and Medicaid Services, said the agency erred when listing the prescription drug plans available with no monthly premium for low-income beneficiaries.

The booklets listed all of the plans available for those with limited assets and income as having no monthly premium. But about 40 percent of the plans actually qualify for no premium.

Karr said the agency will work with groups to help people get the correct information. It will also instruct companies not approved to offer zero premiums on what they can tell potential enrollees.

“It must tell them our plan can’t give you a free premium, but there are other plans which can,” Karr said.

The extra subsidy is available for those whose income does not exceed $14,355 for an individual or $19,245 for a couple. Karr blamed the mistake on inadequate proofreading.

I’m sure this will go a long way towards boosting already shaky consumer confidence in the program.

From The Heritage Foundation:

Katrina relief and recovery could cost taxpayers hundreds of billions of dollars in additional spending, driving up deficits, but still the costly new Medicare drug entitlement is scheduled to go into effect on January 1, 2006. Sen. John McCain (R-AZ) says that, in light of Katrina, America’s taxpayers cannot afford this massive and unnecessary Medicare entitlement expansion next year.[1] Meanwhile, members of the House Republican Study Committee have proposed a one-year delay of the benefit to offset rapidly rising Katrina-related costs. Delaying the prescription drug benefit for one or two years would save tens of billions of dollars that could be put to better use in Katrina recovery.

America must help the victims of Hurricane Katrina rebuild their lives and their region, which is a vital part of the nation. This is an urgent necessity. Because the cost will be enormous, Congress must find ways to offset current and projected spending.

Title I of the Medicare Modernization Act of 2003, the universal drug entitlement, is neither necessary nor desirable. The best policy is to repeal most of Title I but retain the Medicare drug discount card and its provision for assistance for low-income seniors. Congress could make this direct assistance even more generous for poor seniors without drug coverage, while going back to the drawing board to create a more rational and fiscally responsible drug Medicare benefit. A redrawn benefit should target increasingly limited taxpayers dollars to those seniors who need help the most.

Short of repeal of Title I, Congress could delay implementation of the Medicare drug provisions for one or preferably two years. Again, Congress could still retain the Medicare drug discount card and continue to use it to target direct assistance to needy seniors who lack prescription drug coverage. The Medicaid dual-eligible population would remain in Medicaid for prescription drug coverage during any period of delay. This, in substance, is the policy embodied in The Prescription Drug Cost Containment Act of 2005 (H.R. 1382), authored by Rep. Jeff Flake (R-AZ).

I think it may be a little late in the game for this to actually happen. The pharmacies, drug companies, and insurance companies have already invested tons of time and money into preparing for this plan… I would be quite surprised to see it get delayed at this point.

http://www.genengnews.com/news/bnitem.aspx?name=1061050XSL_NEWSML_TO_NEWSML_WEB.xml

WellCare Health Plans, Inc. announced today that it has formed an alliance with Walgreens Health Initiatives, Inc., a wholly owned subsidiary of Walgreen Co., for Medicare Part D Prescription Drug Plans (PDP). WellCare will make educational information available to Walgreens customers at pharmacy counters in each of Walgreens more than 4,950 retail locations nationwide. Those customers who enroll via this alliance will be issued a joint WellCare/Walgreens prescription drug card allowing prescriptions to be filled at participating pharmacies nationwide, including any Walgreens store.

“With its outstanding reputation for quality and its extensive network of retail stores, Walgreens is an excellent partner to help educate beneficiaries about the benefits of WellCare’s national PDP programs,” stated Todd S. Farha, President and Chief Executive Officer of WellCare Health Plans. “We are excited about the opportunity to extend prescription drug coverage to Medicare beneficiaries nationwide, and we are confident that our alliance with Walgreens will contribute to the successful launch of the Medicare prescription drug program.”

“Partnering with WellCare will help us deliver accurate, timely information to our pharmacy patients,” said Don Huonker, Walgreens vice president of pharmacy services. “Not only will our Medicare-eligible patients receive information from a trusted source, but they will have ready access to comprehensive pharmacy benefits offered by WellCare’s PDP programs.”

In addition to honoring WellCare PDP cards at its pharmacies, Walgreens will also accept PDP cards from other PDP providers as well. Medicare beneficiaries who enroll in one of WellCare’s three national PDP programs may fill their prescriptions at more than 40,000 pharmacies nationwide, in addition to the more than 4,950 Walgreens locations.

I’m sure we’re going to see a lot more alliances like this pop up over the next few weeks.

From the Savannah Morning News:

Paying a monthly premium of about $32, as well as the first $250 of drug costs a year, doesn’t sound like affordable prescription drug coverage to Lula Mae Herron.

John Tomat’s first question for private plans: “Will they be allowed to make their premiums go up and down whenever they want?”

Bill Broker, executive director of Georgia Legal Services, said the Medicare prescription drug plan seems designed to fail. He said the pharmaceutical companies are going to benefit, especially because the plan prohibits Medicare from negotiating lower prices on drugs.

“It’s better than nothing,” Broker said. “But in my opinion it could have been much better.”

While no one will argue that the ability for Medicare to negotiate lower prescription prices wouldn’t be a huge benefit to the Medicare Part D Rx Drug program, I’m surprised that there is this much discontent about what the program does cover. For $30-35/month, an open enrollment prescription drug plan like this will provide huge cost savings for lots of seniors across the country. It may not provide the free lunch that everyone seems to be looking for, but it will help those that really need it.

As you are probably aware, the prescription drug insurance plans under Medicare Part D are going to be offered by private companies. On October 1st, these companies are going to be allowed to begin marketing their plans to the seniors, to create product awarness for the November 15th enrollment date.

According to the Pittsburgh Post-Gazette:

“The gold rush starts in October,” Snedden said. Medicare recipients “are going to be the nuggets.”

“I wouldn’t describe it as a gold rush,” said Edmund E. Kroll, an analyst who follows managed care companies for S.G. Cowen & Co. in New York. “But it’s a big opportunity and I think the companies, the better-positioned ones especially, want to make sure they have their ducks in a row when this whole thing kicks in. It’s certainly a major new revenue and profit opportunity.”

Overview:

Medicare Part D is the new prescription drug benefit program scheduled to begin on January 1st, 2006. The Medicare Part D Insurance Policies are going to be administred by private companies, and cost approximately $35 per month. Anyone currently enrolled in Medicare Part A and/or Part B are eligible to enroll in a Part D Prescription Drug Plan.

Enrollment:

There is a six month open enrollment period for eligible individuals, starting November 15, 2005. Anyone who does not enroll in a Medicare Part D plan by May 15, 2006 (and does not have coverage equal to a Part D Plan) will have to pay a 1% penalty for every month they wait to enroll.

Benefits:

While the individual insurance companies can choose to enhance the benefits offered to their Medicare Part D enrollees, here are the mandatory deductibles and copays that all plans will feature.

Please note that these are annual copays, so they start over every year.

1: You pay 100% of the first $250 of prescription drug expenses.

2: The Insurer then pays 75% of prescription drug expenses between $250 and $2,250. This means you have a 25% copay.

3: Then we reach the “donut hole.” You pay 100% of your prescription costs between $2,250 and $5,100.

4: After $5,100 in prescription drug expenses, the program will pay 95% of all your prescription drug costs for the rest of the year.

How do I stay informed?

If you would like to receive detailed information on the Medicare Part D Prescription Drug Insurance Program, please fill out the form below. When
details become available, we will send them to you, including the best plans available in your area.

According to an Associated Press Article, the amount of medicare patients that say they looked favorably upon the upcoming part d drug benefit has finally caught up with those that say they didn’t.

“The positive drum beat has caught up with the negative one,” said Drew Altman, president and CEO of the Kaiser Family Foundation, which specializes in health research. “But on an individual basis, most seniors still can’t answer the big question: ‘What does it mean for me?’”

In the survey, which was conducted earlier this month, the percentages of people who viewed the drug benefit favorably and unfavorably stood at 32 percent each. The remaining 36 percent said they didn’t have enough information to give an opinion.

When the foundation began its survey in February 2004, the numbers were 55 percent unfavorable and 17 percent favorable.

From the Cincinnati Enquirer:

Medicare plans to cut doctor fees by an average of 26 percent over the next six years, starting with a 4.3 percent cut effective Jan. 1. The AMA claims the cuts will force many doctors to limit how many new Medicare patients they accept.

“Physicians want to serve senior patients, but they cannot afford to accept an unlimited number of new Medicare patients into their practices if Medicare payments do not keep up with the cost of providing care,” said Dr. J. Edward Hill, AMA president.

“In Ohio, Medicare payments to physicians will be cut nearly $5 billion over the next six years - that’s a huge loss of federal dollars that should be going toward caring for our state’s Medicare patients,” said Dr. Molly Katz, a Cincinnati physician who also is president of the Ohio State Medical Association.

The AMA plans to run a series of radio and newspaper ads urging Congress to step in to reduce or eliminate the proposed cuts.

From the Medicare Camp:

Medicare officials have said the rate cuts are needed because the program has been spending more than it expected on doctor bills in recent years. Physician outlays grew 13 percent last year, and 8 percent the year before.

The proposed cuts reflect a “sustainable growth formula” built into the Medicare payment system. When spending outpaces expectations in one year, rate cuts are designed to follow the next year to keep spending at an affordable pace.

That formula has called for doctor rate cuts every year since 2001, but the only cut that actually took effect occurred in 2002. Every year since then, Congress has stepped in to override the formula.

It seems to boil down to this: Medicare payouts in their current form are not sustainable. We either need spending to decrease or funding to increase… the money has to come from somewhere. If it doesn’t come out of the doctor’s end, it will either have to come from the seniors in the form of higher premiums, or from the general population in the form of higher taxes.

North Carolina based Kerr Drug is launching a Medicare Part D Information Program as a service to their senior clients.

According to their press release:

Various organizations, some legitimate - others not - are bombarding seniors with various messages and directions on how to obtain this additional coverage. So many messages have been sent out that North Carolina Insurance Commissioner Jim Long issued a press release warning senior citizens to be aware of the aggressive marketing of Medicare Advantage plans by insurance companies, and for seniors to become familiar with what is legal and what resources they can turn to for advice.

Hopefully this pointless finger pointing won’t be too common as marketing efforts from both insurance companies and pharmacy chains steps up.