The Centers for Medicare and Medicaid Services has a slogan for the open enrollment period for Plan D Prescription Drug Coverage Nov. 15 through Dec. 31: “Plans change, you change, shop and compare.”
Monthly premiums have increased, significantly in some cases, the maximum deductible has gone up $20 to $295 and six plans have discontinued prescription coverage in Kansas. The lowest premium available is $17.40, up from $14.90 a year ago. The base benefit premium, on which penalties are calculated, has increased from $27.93 to $30.36.
Humana, a popular plan in Kansas when Plan D was implemented in 2006, because of its $9 monthly premium, will charge $41.90 for 2009, with a deductible of $295, according to Jeanette Gaider, a volunteer with Senior Health Insurance Counseling of Kansas (SHICK) and the Prescription Assistance Program at Pratt Regional Medical Center. The company’s zero deductible plan will increase from $20.90 to $38.50.
All companies that offer Plan D coverage have been approved by Medicare, so they are reliable, even if the company is not a familiar one, Gaider said. There are differences in premiums, deductible amounts, co-pay structures and formularies (drugs covered).
Plan D participants should have received an annual notice of change by Oct. 31. It could have been in the form of a newsletter, a plan brochure or a formal letter, said Natalie Myers, health insurance specialist with the Centers for Medicare and Medicaid Services in Kansas City. Anyone who doesn’t remember getting one or discarded it, thinking it was unimportant, should contact the plan provider for a new copy.
The CMS has mailed notices to participants who qualify for subsidies.
Each year as Medicare beneficiaries become eligible for extra help, if they do not choose a plan, CMS randomly assigns them to a plan with a zero dollar premium. If the plan to which they were assigned has had a premium increase, they will receive a letter on blue paper, advising them they will be reassigned effective Jan. 1 and encouraging them to contact the new company to make sure the medications they take are covered and the pharmacies they like to use are included. The individual can make their own choice, Myers stressed.
Letters on tan paper have been sent to extra help participants who chose their own plan, giving them a list of current zero premium plans in the area. They will not be reassigned, Myers said, but they will be informed.
In Kansas, 10 plans offer zero premiums for eligible individuals. Resource levels for full subsidy are $8,100 for an individual and $12,910 for a married couple. Partial subsidies are available for individuals with resources of $12,510 and couples with $25,010. Resources include savings, investments and real estate, but not the home they live in, their vehicle, personal possessions and burial plots.
Thirty-eight percent of Medicare Plan D participants in Kansas receive the extra help or subsidies, Myers said, but many more Kansans may be eligible but have not applied.
Eligibility for Plan D is not based on income; anyone who qualifies for Medicare because they have reached age 65, or at a lower age with certain disabilities, or any age when diagnosed with end-stage renal disease, and has no other prescription insurance is eligible. A person has seven months after reaching the benchmarks to apply. Not doing so within that time period can be costly.
“It’s like any other insurance — house or auto — you have to get insurance in advance of the need,” Gaider said.
A penalty of 1 percent per month of the base benefit premium for not applying when eligible was applied in 2008 and adds to the monthly premium unless or until a beneficiary qualifies for subsidies.
“It’s important to realize that Plan D is an insurance product and is based on premiums,” Myers said. “If many beneficiaries waited to sign up until they needed to utilize the plan significantly, Medicare couldn’t afford to provide the coverage.”
Resources
• A Medicare Prescription Drug Plan finder is online at www.medicare.gov. A personalized search can be performed by keying in information from the Medicare card, zip code, drugs needed and preferred pharmacies. Enrollment can be made online after Nov. 15.
• Customer service representatives can make comparisons for a caller 24 hours a day, seven days a week at 1-800-633-4227. Have the Medicare card, zip code and pill bottles or list of drugs, dosages and how often taken available.
• SHICK volunteers are located on the fourth floor of the east complex at PRMC, 9 a.m. to noon Tuesday, 9 a.m. to noon and 1 to 3 p.m. Wednesday and 1 to 4 p.m. Thursday. Call 450-1422 or 1-888-900-7762, ext. 422, or walk in.
• For information about subsidies, visit www.socialsecurity.gov, call 1-800-772-1213 7 a.m. to 7 p.m. or visit the nearest Social Security office in Hutchinson.
Pratt, Kan. —
