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The ABCs of Part D: Navigating the maze Frequently asked questions about the new Medicare prescription drug program
Feb. 2, 2006 Retirees Bill and Judy Schultz check over their prescriptions in their Saratoga County home. If you're flummoxed by the complexities of the new Medicare prescription drug program, you're not alone. Medicare Part D, the federal program that began making drug coverage available to Medicare-eligible retirees Jan. 1 "is so complicated I get more gray hairs every time I read the details," says Laurie Kupperstein of NYSUT Social Services. If your local union or any agencies that service seniors are sponsoring training sessions on the new federal program, "we advise you to attend a few — not just one — to get even a minimum understanding of the pitfalls and advantages to Medicare Part D for you," Kupperstein suggests. Should you sign up? Should you wait? Suppose you already have retiree prescription drug coverage? If you're 65 or over — or disabled — you've got serious choices to make, but you do have until May 15 to make them if you're not now receiving drug coverage through Medicaid. In the meantime, take a deep breath and look below for answers to some common questions that you and your colleagues throughout the state have been asking about Medicare Part D. Q: Should I enroll in a Part D prescription drug plan? A: If you have no prescription drug coverage now, experts say you should compare the many private plans now being offered — and sign up for one by the May 15 deadline. If you miss the deadline, Medicare will add a penalty to your premium — 1 percent of the average national premium — for every month you delay. And you'll pay that penalty for as long as you're enrolled. A 2002 survey by New York State United Teachers found that 99.6 percent of all NYSUT retirees had access to employer-provided medical plans, although not all of those plans necessarily provide prescription drug coverage. If you already have drug coverage from a former employer, you're likely better off staying with your current plan if its coverage is "creditable" — at least as good as the basic Medicare plan. As of Nov. 15, your former employer or plan administrator should have notified you in writing about the plan's creditability. If you don't have that notification, call them and ask for it. And be sure to save it in the event you enroll in Part D in the future. Q: How do I know which plan is best for me? A: To help decide which of the many private plans best suits your individual needs, make a list of the prescription drugs you take, your daily dosages, how much you pay for them and which pharmacy you utilize. Compare your list with what each plan covers. You can also go on the Medicare Web site at medicare.gov, enter the data from your list and compare the different plans that are available in your area. Q: If I have creditable coverage from my former employer, is there any reason to sign up for Part D? A: The federal government's Centers for Medicare and Medicaid Services suggests that if you pay all or most of the premium for your current drug coverage, or if your income and resources are limited and you're eligible for extra help paying for Medicare prescription drug coverage, you will generally pay less for prescription drugs if you opt for a Medicare plan over your current retiree plan. But before you join a Medicare plan, find out from your former employer how that could affect your current retiree coverage. Q: So joining a Medicare drugplan could affect my current coverage? A: Definitely. It could change your retiree prescription drug coverage. You might also find that you're unable to drop your prescription drug coverage without also dropping your retiree health coverage. If other family members are included in the plan, they could be left without coverage. If you drop your current plan, you and any family members who are covered might not be able to get coverage back. Q: Suppose I lose my employer-provided coverage in the future? A: If you have creditable drug coverage and lose it for any reason that is not your fault, you can sign up for a Medicare drug plan without penalty as long as you do so within 62 days of losing your coverage. Q: I have a Medigap plan that covers drugs. How does this coordinate with Part D? A: As of Jan. 1, Medigap plans that cover the cost of prescription drugs (Plans H, I and J) are being phased out. However, Medigap plans with drug benefits that were issued before Jan.1 will remain in force and may be renewed for someone not enrolled in Part D. If you decide to keep the Medigap drug plan and enroll in Part D after it is renewed, the Medigap plan's drug coverage will cease the date that Part D coverage goes into effect, and the cost of the Medigap plan will be adjusted. However, most Medigap plans are not creditable. If you put off signing up for Part D because you have a Medigap plan with prescription drug coverage, you'll face the permanent penalty if and when you do join Part D. Q: Is the premium I pay for Part D coverage deducted from my Social Security check? A: Yes. But you can also pay the Medicare private drug plan directly by check or electronic fund transfer. If you choose to pay the premium yourself and you have assigned your Medicare to an HMO or a preferred provider organization, the plan will probably combine your monthly premiums into one sum. You can have this lump sum either taken out of your Social Security check or pay it yourself directly, but you will not be able to do both. Q: What are my appeal rights under Part D if I feel I need better care than my plan provides? A: Each Medicare drug plan will create its own process for how members request an exception. If the drug you need is not covered by the Medicare drug plan you have chosen or has higher deductibles than other drugs, you or your doctor can ask for an exception when: • the drug you have been using was taken off the list of covered drugs — the formulary — for reasons other than safety; • your doctor prescribes a drug not on your plan because none of the covered drugs work for you; • the plan raises a co-pay on a drug you were using when you joined the plan; or • your doctor prescribes a drug with a higher co-pay after determining that no drug with a lower co-pay is appropriate. Your doctor must write a letter stating that the drug being prescribed is medically necessary because other drugs won't work as well, or may do you harm. Your plan must respond within 72 hours. You can also ask for a response within 24 hours when your "life, health or ability to regain maximum function" is in jeopardy. Q: I still have many questions. Who should I talk to? A: If you currently have retiree drug coverage from a former employer, the employment benefits administrator is the best source of information, particularly on how joining a Medicare drug plan could affect your existing coverage. The staff at NYSUT Social Services welcomes your Part D questions at (800) 342-9810 ext. 6206. NYSUT has also contracted with the Medicare Rights Center of New York City to provide information. Call MRC's toll-free hotline at (800) 333-4114 between 9 a.m. and 3 p.m. or log on to www.medicareinteractive.org/nysut. |
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