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Medicare Drug Coverage Made Simple
By Jim Evans
DEAR JIM: Some of my friends and I so confused about the new Medicare drug prescription program that we don’t know where to start. We’ve received dozens of different offers in the mail, and they are all so difficult to understand. How do we choose the right plan to meet my needs, and what if we make a mistake and choose the wrong plan?
— WORRIED IN WOOSTER
DEAR WORRIED:
Yes, it is confusing, isn’t it? But, as my father always says, “Don’t make a mountain out of a molehill.” And he’s right (again).
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173) is the largest expansion of the Medicare program since 1965. Commonly known as the Medicare Modernization Act, or MMA, it is scheduled to begin offering more than 40 million seniors and disabled Americans access to prescription drug coverage beginning in January 2006. The text alone is more than 400 pages which should give some idea of the complexity of the new law.
However, according to Peter Ashkenaz, spokesman for the Centers for Medicare and Medicaid Services (CMS) in Washington, D.C., the decision is not as difficult as it might seem. “Don’t make it tougher than it really is,” says Ashkenaz. “Just make a list beforehand of what is most important to you such as premium cost, deductible, and coverage (which drugs are covered). Then, sit down at the table with an open mind, with the information spread out in front of you, organize it in terms of what is most important to you according to your list, and discard the rest.”
Coverage is entirely voluntary, but if you sign up after May 15, 2006, you will pay a penalty. Some people may have already signed up under the early “deadline” (Nov. 15 to Dec. 31) and will begin coverage effective Jan. 1, 2006, and many people may not choose to sign up at all if they already have other drug coverage that is better than Medicare’s coverage (e.g. benefits from a current or former employer or union, VA, Tricare, Medicare Advantage). If you later lose this coverage, you will not pay a penalty if you change to a Medicare drug program within 63 days.
And don’t worry if you think you have made a wrong choice because you have the option to change to a different plan every year between Nov. 15 to Dec. 31 without any penalty whatsoever. In fact, if you use few or no drugs now, you might want to start low to protect your options and avoid any later penalties and increase your coverage as your needs change in the future.
In the meantime, I suggest that you sit down with family and friends — perhaps some fellow RSVP volunteers — to help guide you through the different choices. But don’t panic — you still have until May 15, 2006, to make a selection and, while the choices are many, once you have reduced them down to what you need, making an educated decision is easier than you think. It really comes down to this: does the plan cover your specific prescription medications and how much does it cost?
If you have access to a computer, you can refer to www.medicare.gov for help or you can call 1-800-MEDICARE if you have a specific question.
Jim Evans is a 38-year veteran of the health and fitness industry and a nationally recognized consultant on fitness for seniors. He is also host of the popular radio talk show “Forever Young” on San Diego’s KCBQ 1170 AM (KCBQ.com).
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