【技术产业】资深议员提交2007年医药计划的时候到了
发布于 2006-11-13 · 浏览 208 · IP 天津天津
这个帖子发布于 18 年零 184 天前，其中的信息可能已发生改变或有所发展。
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Time for seniors to pick 2007 drug plan
Officials advise signing up for Medicare prescription drug plan as early as possible.
Kathleen O'Dell
News-Leader
Post Comment
It's decision time again for Ozarkers age 65 and older — and any friends or family members who help them with financial decisions.
Between Nov. 15 and Dec. 31, seniors can enroll in a Medicare prescription drug plan — a benefit program launched in 2006 to help older adults and disabled people lower their prescription drug costs. Benefits will begin Jan. 1.
[被屏蔽广告]
Seniors who signed up for a plan during the initial enrollment period that began in November 2005 can also change plans beginning Wednesday.
People who are satisfied with their plan don't have to do anything to keep it; renewal for 2007 is automatic.
But most stand-alone plans raised monthly premiums by an average of $4.50, changed other costs and generally expanded the list of drugs they will cover in 2007, said Nancy Schmidt, with the Kansas City regional office of the Centers for Medicare and Medicaid Services.
The plan you signed up for in 2006 may not be the best plan for you in 2007, so you should compare your current plan with new ones available this year, Schmidt said.
Missourians have 53 stand-alone plan choices for 2007 compared with 41 in 2006, with more offering gap coverage.
"So while there's more to compare, so to speak, there are better options. ... We expect it to improve every year as we go along," Schmidt said.
To help with decision-making, senior agencies will offer one-on-one counseling through Dec. 31, and eight open enrollment clinics are planned in Ozarks towns through the Southwest Missouri Office on Aging.
Medicare officials say they also tweaked the online plan comparison tool since last year so seniors have a more reliable way to compare their expected costs under each plan. That site is still at www.medicare.gov.
"Help is out there," said Dorothy Knowles, executive director of the office on aging in Springfield. "We're already getting lots of calls and lots of walk-ins with requests for help."
Rogersville-area resident Curt Naegler already sought the help of a trusted independent insurance broker, Amy Kern of Roy W. Kern & Associates. She did all the plan comparisons and found the best plan for him.
Naegler said he liked that she represents many companies, so she isn't steering all her clients to one or two plans out of company loyalty.
"That stuff could be overwhelming," Naegler said, "and the secret to managing that is to have a good agent who you trust."
His Humana plan has a $16.34 monthly premium, a $7 co-pay for his 30-day generic drug and a $30 co-pay on his 30-day name-brand prescription. He just learned that his generic drug co-pay in 2007 will drop to $5.
"Ten minutes on the phone, and I don't have to worry about it the rest of the year," Naegler said. "I have the best plan at the most reasonable price for my situation."
Nearly 80,000 southwest Missouri seniors enrolled in one of the 52 available Part D plans last year, Medicare officials said.
The drug benefit, passed by Congress and signed into law by President Bush, saves seniors an average of $1,200 a year, according to Health and Human Services Secretary Mike Leavitt. The level of savings varies, depending on how many drugs a person takes, and the plan's coverage.
Save grief; act by Dec. 8
Senior advocates and policymakers are nervously hoping for a smoother enrollment period than last year's bumpy startup.
Amid the successful enrollments were widespread complaints: Enrollees were bewildered by the coverage details of 52 plans. Medicare help lines jammed under the volume of calls for help. Computer glitches left some enrollees off drug plan rolls and delayed others from getting their drugs on Jan. 1. Pharmacists were besieged.
Medicare officials have improved the computer systems so enrollees can get their prescriptions with minimal problems, Schmidt said. But it's not perfect.
That's why Medicare officials encourage seniors to enroll or make plan changes by Dec. 8, even though enrollment ends Dec. 31.
"We want people to make a change or enroll as early as possible to give the system time to update ... so they won't have problems getting their prescriptions," Schmidt said.
Are you an exception?
You don't have to enroll in a Medicare prescription drug plan if you have a drug benefit through a retirement plan, employer, veterans plan or other plan that is at least as good as standard Medicare coverage. That's called "creditable" coverage. If that plan or coverage level ends after Dec. 31, you may enroll in a Medicare plan without a financial penalty.
Seniors who turn 65 after Dec. 31 have the normal Medicare open enrollment period with no penalty.
There are a few other exceptions to enrollment deadlines and other restrictions. For more information, call Medicare at 1-800-633-4227 or another trusted source.
Enrollment in a Medicare drug plan is voluntary.
Some seniors who take no prescription drugs don't want to pay a monthly premium for a benefit they don't use.
But others, like Floyd Perkins of Nixa, consider it an insurance policy in case he needs prescriptions in 2007. Last year, he signed up for the lowest-cost Humana plan with a $16 monthly premium. His premium is going to $18 in 2007 — but the investment is worth the peace of mind, he said.
A word of warning: Those who don't have other creditable drug coverage and don't enroll by Dec. 31 will face a financial penalty that will be permanently added to each month's premium while they participate in Medicare Part D.
The penalty is 1 percent of the average national monthly premium ($24) for each month you delay in enrolling in a plan. Open enrollment is only once a year. A person who avoided the 2006 signup until now would see $1.68 added to each month's premium beginning Jan. 1. But if he waits longer, and the national premium average goes up, he could see a bigger, cumulative hit on his monthly premiums, Schmidt said.
Changes for 2007
While the benefit is offered nationwide, the number and kinds of plans vary by state. Here are some general changes in Missouri in 2007.
- There are more plans, and monthly premiums still average about $24 a month; the lowest is $14.90.
- The annual deductible for most 2007 drug plans is $265, a $15 increase over last year, Knowles said, but a few plans charge less.
- In general, Missourians will also have more access to Medicare Advantage health plans, generally with lower costs for drug coverage. These plans offer an opportunity for extra benefits beyond those covered in the original Medicare program, Medicare officials say.
- More Missouri plans this year are offering "gap" coverage, but seniors must spend more out of pocket before they reach it in 2007.
The gap, also called the "doughnut hole," is the point at which a senior and his insurer together have spent $2,400 out of pocket on drug copays, and the senior must begin paying the total retail cost of drugs until that amount reaches $5,451.25, Knowles said.
In 2006, the gap began at $2,250 and ended after $3,600.
Medicare has an online fact sheet to help seniors manage their costs during the coverage gap. Visit www.medicare.gov.
As seniors face more choices and less time to enroll for 2007 than the November-to- May period last year, Schmidt offers this advice:
"People should look at their drug plan options based on cost, coverage, convenience and customer service."
Enrollment clinics
Enrollment clinics are planned in eight Ozarks cities. They are sponsored by the Southwest Missouri Office on Aging and congressman Roy Blunt's office.
To best compare drug plans, individuals should bring their Medicare card and a complete list of their prescription drugs, with dosage levels.
Ozark: 9:30 a.m.-1:30 p.m. Friday, Ozarks Technical Community College, 500 W. Daniels St. (Daniels Street at Selmore Road)
Cassville: 10 a.m.-2 p.m. Nov. 20, Crowder College Watley Center, 504 E. 13th St. (park on 13th Street side)
Ash Grove: 9:30 a.m.-1:30 p.m. Nov. 21, Ash Grove branch of Springfield-Greene County Library, 101 Main St.
Branson: 9 a.m.-1 p.m. Dec. 1, Boys & Girls Club of Branson, 1460 Bee Creek Road
Reeds Spring: 9:30 a.m.-1:30 p.m. Dec. 4, Tri-Lakes Telecommunications Community Resource Center, Reeds Spring High School, Missouri 413 South
Monett: 9:30 a.m.-1:30 p.m. Dec. 5, Southwest Missouri Career Center, Scott Avenue and 9th Street (park behind middle school gym)
Bolivar: 10 a.m.-2 p.m. Dec. 6, Polk County Library, 1690 W. Broadway
Mount Vernon: 9:30 a.m.-1:30 p.m. Dec. 7, Barry-Lawrence County Library, 206 W. Water St.
To get help
Several agencies have staff or Web sites to help you compare prescription drug plans and enroll in the best one for you.
Services are free; experts warn seniors not to use a service that charges for the help.
You will need a list of your prescription drugs (brand-name and generic), dosages and your Medicare ID number to compare plans.
Here are some key sources:
- Medicare staff is available by telephone 24 hours a day, toll-free, at 1-800-633-4227.
- Medicare also has an online tool that allows you to enter your drug names and dosages and compare drug plans that cover your specific drugs. No access to the Internet? Ask a friend with access or use the computers at the public libraries.
Go to www.medicare.gov, click on "Compare Medicare Prescription Drug Plans" and follow the prompts.
- The Southwest Missouri Office on Aging, 1735 S. Fort Ave., Springfield, can provide one-on-one help. Appointments are recommended. Call 862-0762 or come by the office. Residents of outlying towns can also call any of the 40 senior centers in 17 surrounding counties, where staff has been trained to help seniors compare plans.
- Southwest Missouri Office on Aging also has dates for regional enrollment clinics, drug plan information and links to the Medicare Web site. Go to www.swmoa.com.
- CLAIM is a nonprofit network of trained volunteers who provide free counseling on Medicare issues such as the prescription drug plan and Medigap insurance. For help, call 1-800-390-3330. An operator will gather information and relay it to a CLAIM volunteer in your area. Within days, a volunteer will call to set up an appointment or provide the information by phone.
- Consult the "Medicare & You 2007" handbook, which beneficiaries received in October. Tables in the back outline all stand-alone drug plans and Medicare advantage plans in brief terms.
- Insurance agents can also help seniors compare and select an appropriate plan. Experts advise seniors to use a trusted agent who will consider all appropriate drug plans.
- The Medicare Rights Center has interactive online tools to help older adults and people with disabilities, their families and caregivers and professionals make decisions about the new Medicare drug benefit and how to apply for the "Extra Help" benefit to help pay for monthly premiums and drug copays. The Web-based tools are at www.medicare rights.org/help. The center, an independent source of Medicare information, also operates a toll-free hotline and provides legal services to help people appeal Medicare private drug plan decisions. There is no fee. Medicare Rights Center's Drug Plan Appeals Hotline offers free assistance at 1-888-466-9050.
How-to guide for enrolling
The enrollment period is Nov. 15 through Dec. 31 for Medicare prescription drug benefits beginning Jan. 1.
Which category are you?
Here's what to do.
You already have a plan
Seniors and people with disabilities who are satisfied with their current Medicare prescription drug coverage do not have to take any action. Benefits will continue uninterrupted for the benefit year beginning Jan. 1.
However, many plans changed their 2007 costs and formularies — the list of drugs they will cover.
Seniors who are satisfied with their 2006 plan should still look at other plans offered in 2007 because they may offer a better plan with lower costs or better coverage, said Nancy Schmidt, with the Kansas City regional office of the Centers for Medicaid and Medicare Services.
Springfield independent insurance agent Amy Kern is already busy answering Part D questions, especially since her existing clients are seeing their plan costs and coverage change for 2007.
"If you stay in a plan you had last year, you might be doing yourself a disservice because you might get better coverage with a plan that just came out. It's a good idea to re-evaluate," Kern said.
You want to change plans
Seniors with a drug plan should have received a letter by Oct. 31 from their drug plan sponsor detailing any changes in costs and coverage, Schmidt said.
Seniors may want to change plans for 2007 for one of several reasons:
- Their coverage is decreasing or costs are rising. Examples: an expensive drug they're taking is no longer covered by the plan, or they have started taking a drug that is not covered by the existing plan.
- They want a less expensive plan with the same or similar coverage.
Barbara Mason of Buffalo enrolled in a drug plan in August after she became permanently disabled and eligible for Medicare.
She found a plan on her own she likes. The Advantage Rx plan has a $32.50 monthly premium and no deductible, offering a savings of about $1,200 a year on her six prescriptions. Her monthly premiums will jump by $5 a month in 2007.
This time around, she's comparing plans with help from the senior program at St. John's Hospital to see if there's a better option for 2007.
"I like to investigate," she said.
If you are considering a change, you can use the same comparison tools as seniors who are signing up for the first time.
Enrolling for the first time
There are more plans to choose from for 2007.
This year, 26 plans offer enhanced benefits or services such as coverage in the "gap" and little or no deductible.
There are 32 plans that have zero deductibles, some of which also offer other enhanced benefits.
The lowest premium in Missouri this year is $14.90, and three plans have a premium below $20 a month.
There are also options that cover generics and preferred brand name drugs through the coverage gap for as low as $43.20, and generally for under $50, Medicare officials say.
Whether you're changing plans or enrolling for the first time, your goal should be to choose a plan suited to your personal needs.
That plan should cover your most expensive prescription drugs.
A plan may not cover all the drugs you're taking.
It should offer the most comprehensive coverage, for the most affordable monthly premium, annual deductible and drug co-pays.
Dorothy Knowles, executive director of the Southwest Missouri Office on Aging, tells her clients: Once you narrow your choices to the plans that cover your most expensive drugs, consider all costs — premiums, co-pays, deductibles and any restrictions such as quantity limits. Don't base your choice solely on the fact a plan has a zero-dollar monthly premium.
Need extra help?
The Missouri RX program expanded for 2007, and applications are being accepted from seniors once they sign up for a Medicare drug plan.
Unlike in 2006, there is no asset test to qualify for the low-income subsidy for drug plan costs, said Knowles.
"There isn't anything that keeps them from being able to qualify," she said.
Those eligible include single seniors with an annual gross income of $19,600 or less, or married seniors with gross annual incomes of $26,400 or less.
Those who qualify will pay only 50 percent of their drug plan deductible, 50 percent of drug copays and 50 percent of out-of-pocket costs during the gap and beyond.
For more information, go to www.dss.mo.gov/dms/cs/morx.htm.
Can you help?
CLAIM, the Medicare assistance program, needs volunteers to help seniors.
The statewide, nonprofit program provides a toll-free help line and free counseling on Medicare issues such as the new prescription drug plan and Medigap insurance.
Help is particularly needed to serve Greene County-area residents, said Tracey Borgmeyer, CLAIM lead trainer.
Volunteers serve the community in which they live. In Greene County, they work with St. John's Hospital, which serves as the local center of operations and sponsors the program.
To receive certification, volunteers must attend an orientation session and four training sessions. Computer skills are required, Borgmeyer said, and the volunteer positions are well-suited for retirees.
To apply to become a volunteer, visit www.missouriclaim. org or call 1-800-390-3330.
CLAIM is a nonprofit program with financial assistance in part through a grant from the Centers for Medicare & Medicaid Services, the federal Medicare agency. Funding is administered through the Missouri Department of Insurance and services are provided by Primaris.
Time for seniors to pick 2007 drug plan
Officials advise signing up for Medicare prescription drug plan as early as possible.
Kathleen O'Dell
News-Leader
Post Comment
It's decision time again for Ozarkers age 65 and older — and any friends or family members who help them with financial decisions.
Between Nov. 15 and Dec. 31, seniors can enroll in a Medicare prescription drug plan — a benefit program launched in 2006 to help older adults and disabled people lower their prescription drug costs. Benefits will begin Jan. 1.
[被屏蔽广告]
Seniors who signed up for a plan during the initial enrollment period that began in November 2005 can also change plans beginning Wednesday.
People who are satisfied with their plan don't have to do anything to keep it; renewal for 2007 is automatic.
But most stand-alone plans raised monthly premiums by an average of $4.50, changed other costs and generally expanded the list of drugs they will cover in 2007, said Nancy Schmidt, with the Kansas City regional office of the Centers for Medicare and Medicaid Services.
The plan you signed up for in 2006 may not be the best plan for you in 2007, so you should compare your current plan with new ones available this year, Schmidt said.
Missourians have 53 stand-alone plan choices for 2007 compared with 41 in 2006, with more offering gap coverage.
"So while there's more to compare, so to speak, there are better options. ... We expect it to improve every year as we go along," Schmidt said.
To help with decision-making, senior agencies will offer one-on-one counseling through Dec. 31, and eight open enrollment clinics are planned in Ozarks towns through the Southwest Missouri Office on Aging.
Medicare officials say they also tweaked the online plan comparison tool since last year so seniors have a more reliable way to compare their expected costs under each plan. That site is still at www.medicare.gov.
"Help is out there," said Dorothy Knowles, executive director of the office on aging in Springfield. "We're already getting lots of calls and lots of walk-ins with requests for help."
Rogersville-area resident Curt Naegler already sought the help of a trusted independent insurance broker, Amy Kern of Roy W. Kern & Associates. She did all the plan comparisons and found the best plan for him.
Naegler said he liked that she represents many companies, so she isn't steering all her clients to one or two plans out of company loyalty.
"That stuff could be overwhelming," Naegler said, "and the secret to managing that is to have a good agent who you trust."
His Humana plan has a $16.34 monthly premium, a $7 co-pay for his 30-day generic drug and a $30 co-pay on his 30-day name-brand prescription. He just learned that his generic drug co-pay in 2007 will drop to $5.
"Ten minutes on the phone, and I don't have to worry about it the rest of the year," Naegler said. "I have the best plan at the most reasonable price for my situation."
Nearly 80,000 southwest Missouri seniors enrolled in one of the 52 available Part D plans last year, Medicare officials said.
The drug benefit, passed by Congress and signed into law by President Bush, saves seniors an average of $1,200 a year, according to Health and Human Services Secretary Mike Leavitt. The level of savings varies, depending on how many drugs a person takes, and the plan's coverage.
Save grief; act by Dec. 8
Senior advocates and policymakers are nervously hoping for a smoother enrollment period than last year's bumpy startup.
Amid the successful enrollments were widespread complaints: Enrollees were bewildered by the coverage details of 52 plans. Medicare help lines jammed under the volume of calls for help. Computer glitches left some enrollees off drug plan rolls and delayed others from getting their drugs on Jan. 1. Pharmacists were besieged.
Medicare officials have improved the computer systems so enrollees can get their prescriptions with minimal problems, Schmidt said. But it's not perfect.
That's why Medicare officials encourage seniors to enroll or make plan changes by Dec. 8, even though enrollment ends Dec. 31.
"We want people to make a change or enroll as early as possible to give the system time to update ... so they won't have problems getting their prescriptions," Schmidt said.
Are you an exception?
You don't have to enroll in a Medicare prescription drug plan if you have a drug benefit through a retirement plan, employer, veterans plan or other plan that is at least as good as standard Medicare coverage. That's called "creditable" coverage. If that plan or coverage level ends after Dec. 31, you may enroll in a Medicare plan without a financial penalty.
Seniors who turn 65 after Dec. 31 have the normal Medicare open enrollment period with no penalty.
There are a few other exceptions to enrollment deadlines and other restrictions. For more information, call Medicare at 1-800-633-4227 or another trusted source.
Enrollment in a Medicare drug plan is voluntary.
Some seniors who take no prescription drugs don't want to pay a monthly premium for a benefit they don't use.
But others, like Floyd Perkins of Nixa, consider it an insurance policy in case he needs prescriptions in 2007. Last year, he signed up for the lowest-cost Humana plan with a $16 monthly premium. His premium is going to $18 in 2007 — but the investment is worth the peace of mind, he said.
A word of warning: Those who don't have other creditable drug coverage and don't enroll by Dec. 31 will face a financial penalty that will be permanently added to each month's premium while they participate in Medicare Part D.
The penalty is 1 percent of the average national monthly premium ($24) for each month you delay in enrolling in a plan. Open enrollment is only once a year. A person who avoided the 2006 signup until now would see $1.68 added to each month's premium beginning Jan. 1. But if he waits longer, and the national premium average goes up, he could see a bigger, cumulative hit on his monthly premiums, Schmidt said.
Changes for 2007
While the benefit is offered nationwide, the number and kinds of plans vary by state. Here are some general changes in Missouri in 2007.
- There are more plans, and monthly premiums still average about $24 a month; the lowest is $14.90.
- The annual deductible for most 2007 drug plans is $265, a $15 increase over last year, Knowles said, but a few plans charge less.
- In general, Missourians will also have more access to Medicare Advantage health plans, generally with lower costs for drug coverage. These plans offer an opportunity for extra benefits beyond those covered in the original Medicare program, Medicare officials say.
- More Missouri plans this year are offering "gap" coverage, but seniors must spend more out of pocket before they reach it in 2007.
The gap, also called the "doughnut hole," is the point at which a senior and his insurer together have spent $2,400 out of pocket on drug copays, and the senior must begin paying the total retail cost of drugs until that amount reaches $5,451.25, Knowles said.
In 2006, the gap began at $2,250 and ended after $3,600.
Medicare has an online fact sheet to help seniors manage their costs during the coverage gap. Visit www.medicare.gov.
As seniors face more choices and less time to enroll for 2007 than the November-to- May period last year, Schmidt offers this advice:
"People should look at their drug plan options based on cost, coverage, convenience and customer service."
Enrollment clinics
Enrollment clinics are planned in eight Ozarks cities. They are sponsored by the Southwest Missouri Office on Aging and congressman Roy Blunt's office.
To best compare drug plans, individuals should bring their Medicare card and a complete list of their prescription drugs, with dosage levels.
Ozark: 9:30 a.m.-1:30 p.m. Friday, Ozarks Technical Community College, 500 W. Daniels St. (Daniels Street at Selmore Road)
Cassville: 10 a.m.-2 p.m. Nov. 20, Crowder College Watley Center, 504 E. 13th St. (park on 13th Street side)
Ash Grove: 9:30 a.m.-1:30 p.m. Nov. 21, Ash Grove branch of Springfield-Greene County Library, 101 Main St.
Branson: 9 a.m.-1 p.m. Dec. 1, Boys & Girls Club of Branson, 1460 Bee Creek Road
Reeds Spring: 9:30 a.m.-1:30 p.m. Dec. 4, Tri-Lakes Telecommunications Community Resource Center, Reeds Spring High School, Missouri 413 South
Monett: 9:30 a.m.-1:30 p.m. Dec. 5, Southwest Missouri Career Center, Scott Avenue and 9th Street (park behind middle school gym)
Bolivar: 10 a.m.-2 p.m. Dec. 6, Polk County Library, 1690 W. Broadway
Mount Vernon: 9:30 a.m.-1:30 p.m. Dec. 7, Barry-Lawrence County Library, 206 W. Water St.
To get help
Several agencies have staff or Web sites to help you compare prescription drug plans and enroll in the best one for you.
Services are free; experts warn seniors not to use a service that charges for the help.
You will need a list of your prescription drugs (brand-name and generic), dosages and your Medicare ID number to compare plans.
Here are some key sources:
- Medicare staff is available by telephone 24 hours a day, toll-free, at 1-800-633-4227.
- Medicare also has an online tool that allows you to enter your drug names and dosages and compare drug plans that cover your specific drugs. No access to the Internet? Ask a friend with access or use the computers at the public libraries.
Go to www.medicare.gov, click on "Compare Medicare Prescription Drug Plans" and follow the prompts.
- The Southwest Missouri Office on Aging, 1735 S. Fort Ave., Springfield, can provide one-on-one help. Appointments are recommended. Call 862-0762 or come by the office. Residents of outlying towns can also call any of the 40 senior centers in 17 surrounding counties, where staff has been trained to help seniors compare plans.
- Southwest Missouri Office on Aging also has dates for regional enrollment clinics, drug plan information and links to the Medicare Web site. Go to www.swmoa.com.
- CLAIM is a nonprofit network of trained volunteers who provide free counseling on Medicare issues such as the prescription drug plan and Medigap insurance. For help, call 1-800-390-3330. An operator will gather information and relay it to a CLAIM volunteer in your area. Within days, a volunteer will call to set up an appointment or provide the information by phone.
- Consult the "Medicare & You 2007" handbook, which beneficiaries received in October. Tables in the back outline all stand-alone drug plans and Medicare advantage plans in brief terms.
- Insurance agents can also help seniors compare and select an appropriate plan. Experts advise seniors to use a trusted agent who will consider all appropriate drug plans.
- The Medicare Rights Center has interactive online tools to help older adults and people with disabilities, their families and caregivers and professionals make decisions about the new Medicare drug benefit and how to apply for the "Extra Help" benefit to help pay for monthly premiums and drug copays. The Web-based tools are at www.medicare rights.org/help. The center, an independent source of Medicare information, also operates a toll-free hotline and provides legal services to help people appeal Medicare private drug plan decisions. There is no fee. Medicare Rights Center's Drug Plan Appeals Hotline offers free assistance at 1-888-466-9050.
How-to guide for enrolling
The enrollment period is Nov. 15 through Dec. 31 for Medicare prescription drug benefits beginning Jan. 1.
Which category are you?
Here's what to do.
You already have a plan
Seniors and people with disabilities who are satisfied with their current Medicare prescription drug coverage do not have to take any action. Benefits will continue uninterrupted for the benefit year beginning Jan. 1.
However, many plans changed their 2007 costs and formularies — the list of drugs they will cover.
Seniors who are satisfied with their 2006 plan should still look at other plans offered in 2007 because they may offer a better plan with lower costs or better coverage, said Nancy Schmidt, with the Kansas City regional office of the Centers for Medicaid and Medicare Services.
Springfield independent insurance agent Amy Kern is already busy answering Part D questions, especially since her existing clients are seeing their plan costs and coverage change for 2007.
"If you stay in a plan you had last year, you might be doing yourself a disservice because you might get better coverage with a plan that just came out. It's a good idea to re-evaluate," Kern said.
You want to change plans
Seniors with a drug plan should have received a letter by Oct. 31 from their drug plan sponsor detailing any changes in costs and coverage, Schmidt said.
Seniors may want to change plans for 2007 for one of several reasons:
- Their coverage is decreasing or costs are rising. Examples: an expensive drug they're taking is no longer covered by the plan, or they have started taking a drug that is not covered by the existing plan.
- They want a less expensive plan with the same or similar coverage.
Barbara Mason of Buffalo enrolled in a drug plan in August after she became permanently disabled and eligible for Medicare.
She found a plan on her own she likes. The Advantage Rx plan has a $32.50 monthly premium and no deductible, offering a savings of about $1,200 a year on her six prescriptions. Her monthly premiums will jump by $5 a month in 2007.
This time around, she's comparing plans with help from the senior program at St. John's Hospital to see if there's a better option for 2007.
"I like to investigate," she said.
If you are considering a change, you can use the same comparison tools as seniors who are signing up for the first time.
Enrolling for the first time
There are more plans to choose from for 2007.
This year, 26 plans offer enhanced benefits or services such as coverage in the "gap" and little or no deductible.
There are 32 plans that have zero deductibles, some of which also offer other enhanced benefits.
The lowest premium in Missouri this year is $14.90, and three plans have a premium below $20 a month.
There are also options that cover generics and preferred brand name drugs through the coverage gap for as low as $43.20, and generally for under $50, Medicare officials say.
Whether you're changing plans or enrolling for the first time, your goal should be to choose a plan suited to your personal needs.
That plan should cover your most expensive prescription drugs.
A plan may not cover all the drugs you're taking.
It should offer the most comprehensive coverage, for the most affordable monthly premium, annual deductible and drug co-pays.
Dorothy Knowles, executive director of the Southwest Missouri Office on Aging, tells her clients: Once you narrow your choices to the plans that cover your most expensive drugs, consider all costs — premiums, co-pays, deductibles and any restrictions such as quantity limits. Don't base your choice solely on the fact a plan has a zero-dollar monthly premium.
Need extra help?
The Missouri RX program expanded for 2007, and applications are being accepted from seniors once they sign up for a Medicare drug plan.
Unlike in 2006, there is no asset test to qualify for the low-income subsidy for drug plan costs, said Knowles.
"There isn't anything that keeps them from being able to qualify," she said.
Those eligible include single seniors with an annual gross income of $19,600 or less, or married seniors with gross annual incomes of $26,400 or less.
Those who qualify will pay only 50 percent of their drug plan deductible, 50 percent of drug copays and 50 percent of out-of-pocket costs during the gap and beyond.
For more information, go to www.dss.mo.gov/dms/cs/morx.htm.
Can you help?
CLAIM, the Medicare assistance program, needs volunteers to help seniors.
The statewide, nonprofit program provides a toll-free help line and free counseling on Medicare issues such as the new prescription drug plan and Medigap insurance.
Help is particularly needed to serve Greene County-area residents, said Tracey Borgmeyer, CLAIM lead trainer.
Volunteers serve the community in which they live. In Greene County, they work with St. John's Hospital, which serves as the local center of operations and sponsors the program.
To receive certification, volunteers must attend an orientation session and four training sessions. Computer skills are required, Borgmeyer said, and the volunteer positions are well-suited for retirees.
To apply to become a volunteer, visit www.missouriclaim. org or call 1-800-390-3330.
CLAIM is a nonprofit program with financial assistance in part through a grant from the Centers for Medicare & Medicaid Services, the federal Medicare agency. Funding is administered through the Missouri Department of Insurance and services are provided by Primaris.
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