Now that the holidays are in full swing, many elderly
and disabled people in the lower-income brackets are
faced with hard choices. Gift-giving is the first thing
that comes to mind, but a bigger issue is coming that
will change lives.
Medicare Part D is now enrolling thousands of people
who utilize Medicaid for their prescription drug needs.
This large group will automatically be enrolled in the
Part D drug program. The hard decisions are about which
plan to choose and how to assess prescription drug needs
for the year ahead.
The Medicare Part D program does not provide a
Medicare benefit directly. Rather, it creates a right
for Medicare beneficiaries to purchase prescription drug
coverage from a Medicare prescription drug plan.
Prescription drug plans can be stand-alone plans, or
individuals can enroll in a Medicare Part C managed-care
plan - now called Medicare Advantage health plans.
With Medicare Part D, people who relied on Medicaid
for their prescription drugs will now have to follow the
rules set by Medicare. While there are benefits to this,
there are also pitfalls that must be carefully thought
through and decided upon before the program goes into
effect Jan. 1.
For example, Medicare has the ability to restrict
coverage of allergy medications to just two kinds. If
your usual allergy medication is not part of the Part D
formulary, or coverage list, you will need to apply for
an exception through a Medicare physician.
Federal officials have recommended - but have not
required - that the plans provide a temporary
"first fill" supply of a drug, so that clients
can access their drugs and be given a certain amount of
time to make any necessary switches in treatment
regimens. Federal officials are requiring that Part D
plans dispense a temporary supply of non-formulary drugs
for residents of nursing homes and other long-term care
facilities.
The ability to choose which drug plan or private
insurance carrier you want might seem like a benefit.
But there's always the fine print, and many elderly and
disabled people in nursing homes and long-term care
facilities may not have such choices, if the facility
recommends one insurance carrier for everyone who is on
Medicaid.
There is a provision called "Extra Help,"
which aids clients who fall within certain income
brackets in paying for the monthly premiums, the
deductibles and co-pays. But when clients reach the
dollar amount at which Part D requires them to pay for
the drugs in full, until the next coverage level, many
clients would not be able to afford medication until the
next fiscal year.
There are many publications available from private
insurance companies and pharmacies that try to explain
the new drug program. Read them thoroughly. Don't be
afraid to ask questions. Write down what you are told
and verify it.
It's too costly to risk the regrets of hindsight with
this new program.
McKee, a wheelchair user, is a poet and producer.
You can e-mail her at chairgrrl@chairgrrl.com.
Her column runs on Tuesdays.
