Like many medical insurance plans, a new prescription drug benefit available to Medicare recipients starting Jan. 1, comes with lots of questions and difficult to understand answers.
Luckily for about 20 people who attended an information meeting at the Kenai Senior Citizens Center on Thursday, administrative assistant Kathy Romain has been trained to answer the questions in plain English.
Until now, prescription drugs were not covered under Medicare, but as of the first of the year, they will be as long as people enroll for the coverage.
Enrollment in the new program, known as Medicare Part D, begins Nov. 15 and runs through May 15. Those who enroll by Dec. 31 will have prescription drug coverage as of Jan. 1.
Romain said that for those who don't enroll in the first year, the drug benefit will have an open enrollment period of Nov. 15 to Dec. 31 in subsequent years.
The open enrollment period, similar to those in effect with employer insurance plans, allow qualified people to enroll only during specified periods of time.
The way the Medicare prescription drug benefit works is, Medicare contracts with private companies to offer prescription drug plans to Medicare recipients.
The recipients must select one of those drug plans. Eleven plans will be available in Alaska.
Beginning Thursday, people will be able to compare the plans online at www.medi-care.gov.
Romain said she will be available to help people make a choice. She recommended setting up an appointment to meet with her at the Kenai senior center.
Under the basic prescription drug plan, people who sign up will pay a monthly premium of between $20 and $65 in Alaska.
The covered person will pay a $250 deductible amount each year and then Medicare will pay 75 percent of the next $2,000 in drug costs.
After total drug costs reach $2,250, the individual will pay 100 percent on the next $2,850. After drug costs reach $5,100, Medicare pays for 95 percent of additional drug costs.
Seniors already are asking what they need to do if they already have medical insurance or retirement insurance that provides what Medicare Part D covers.
"You don't have to do anything," Romain said.
"You will receive a letter from your insurance company stating your coverage is as good as or better than Part D," she said.
People with an employer or union insurance plan with drug coverage also will be notified if their plan's prescription benefit is at least as good as the Medicare drug coverage.
If the person's current prescription drug plan offers less coverage than Part D, they can keep their current plan and add a Medicare drug plan to give more complete coverage.
"Most of the time, if you're on the (Veterans Administration) drug benefit, it's better than Part D," Romain said.
Monthly premiums for Part D coverage come directly from a senior's Social Security check, she said.
People with limited income and resources who cannot afford a prescription drug plan will qualify for "extra help," according to Romain.
In Alaska, that means single persons with annual income below $17,925 or married persons living with their spouse whose income is below $24,045.
Resources, not including home and car, must also be below $11,500 and $23,000 for singles and married couples, respectively, to qualify for the extra help.
The amount of help depends on the amount of income and resources the person has.
The following time line will guide people through the enrollment procedure.
n In October, Medicare will send a letter about enrolling in Part D as well as a new "Medicare and You 2006" handbook.
n Thursday, prescription drug plans will be posted on Medicare's Web site, www.-medicare.gov.
n Nov. 15, enrollment opens for Medicare Part D Prescription Drug benefit. Enrollment remains open through May 15.
n Jan. 1, prescription drug benefit begins.
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