SPECIAL REPORT

If life were a cartoon, spirals might swirl these days in the eyes of seniors trying to make sense out of Medicare's new drug plans.

To many, Medicare Part D stands for Doom, Death and Debacle, but consider two other D words: Don't Despair. There are ways of declawing the process, strategies for picking a plan before the May 15 deadline and even -- dare one say it? -- a little light inside the dreaded "doughnut hole" in coverage.

The waits on Medicare and drug plan phone lines are now shorter, pioneer enrollees have plenty of lessons to share, and Medicare's Web site offers options that narrow the search for plans.

In New York State, there are 47 plans, with monthly premiums from $4.10 to $85.02. Some have annual deductibles -- $250 is the maximum allowed under the law -- and there are drug co-pays and coinsurance, in which the plan pays a percentage and you pay the rest.

But many seniors feel trapped, unable to pay for drugs by themselves, yet disenchanted with Part D's prices and resentful of the lifetime, snowballing penalty on the premium if they enroll late.

Plus, what you pay for in Part D may not always be what you'll get. Plans can change their coverage at any time, dropping drugs or raising pill prices. They don't have to pay for what the doctor prescribed and can require you to take generics or less costly alternatives, unless you go through the appeals system and win.

To sign or not to sign

With few guarantees but so many footnotes and exceptions twined into Part D, it's hard to generalize about who should buy in or opt out.

The Nassau County Department of Senior Citizen Affairs, like its municipal counterparts, has contracted out or held Part D seminars for seniors and caseworkers. "The very first question would be 'How are you currently paying for drugs?'" said Judy Clark, director of the department's support services.

But if you're barely taking an aspirin, why sign up?

Westbury retiree Ben Pardo was lucky enough to be that healthy -- until four years ago, when he had a heart attack.

Now, in the midst of narrowing his plan options, the former pharmacist thinks of Part D the way he thinks of car insurance: You're protected if you ever get into trouble; and if you don't have any insurance, you're gambling on not getting into trouble and often paying a high price if you do.

"Today, if you were 65 years of age and you were taking no medication, your first thought would be, 'Well, why should I give the government a piece of my Social Security every month to cover my Part D?' " said Pardo, 74. "Tomorrow, you may have a myocardial infarction and be on the same boat that I'm in, where your drug bills go from nothing to eight, nine, ten thousand dollars a year."

Many people don't even have to bother decoding Part D, because their job-related prescription coverage is "creditable," which means it's as good as or better than Medicare Part D. That includes Veterans Affairs coverage, federal retiree benefits, some Medicare managed-care plans and EPIC, the state's drug program for low-income seniors.

"A lot of people on Long Island have coverage from somewhere else," said Holly Rhodes-Teague, director of Suffolk's Office for the Aging. "A lot of people are getting crazy for no reason."

By now, employers and unions should have sent out notification on creditable coverage. Keep those documents -- they're the get-out-of-penalty cards if you enroll in Part D later or if your job-related coverage later becomes non-creditable, in which case, you have 63 days to sign up without a penalty.

"If you didn't get the letter or you're not sure . . . call the benefits manager for the former employer or union," Clark said.

But people with job-related, creditable drug benefits should be careful for two reasons.

First, many companies and unions will get federal subsidies for each person they cover, so some will eliminate drug and even health benefits of those who choose to join Part D.

Second, creditable is not forever in this era of high health care costs and budget-conscious employers.

 

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Health: Nutrition

Rick Brand
POLITICS & POWER

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