As people age, they usually require more medical attention and have greater risk of chronic and life-threatening illnesses. To battle these conditions, many seniors are on a wide range of medications with a combined cost that can be a significant financial burden, especially for those living on retirement savings and Social Security.
The government-provided prescription drug plan falls under the Medicare program and can ensure drug coverage for those who need it. There are some important points to note about the Medicare Drug Plan. First, you should know that you are not automatically signed up for a prescription plan, even if you are currently on Medicare. Secondly, there are enrollment deadlines and possible penalties associated with missing those deadlines.
The Medicare Drug Plan is available to individuals who are on or are eligible for Medicare and do not currently have another drug plan. Medicare eligibility starts at age 65 younger if you have a qualifying medical disability. It works like private insurance in that there are monthly premiums, deductibles and co-pays.
"There is a huge segment of the population without a prescription drug plan," says Wendy Arnold Ohle, insurance counselor for the East Jefferson General Hospital Elder Advantage program. "People often think that because they are currently on Medicare that they have drug coverage, but that is not the case. I cannot stress enough the importance of looking at your options and making sure you enroll on time."
Dec. 31 concludes the enrollment period for coverage in 2007. If you are on Medicare without prescription drug coverage and you miss the deadline, you will be assessed a 1 percent per month penalty on your premium when you do enroll. The next enrollment period for the 2008 calendar year will not begin until Nov. 15.
Under the Medicare Prescription Plan, there are 51 different options in Louisiana; all have varying monthly premium rates, different co-pays and deductibles, and coverage limitations depending on the amount and type of medications you use from a pharmacy in that calendar year. Because the selected plan cannot be changed until the following year, it is best to look closely at all the plans before making a decision.
"It is a confusing process, and I tell people that they don't want to get stuck with a plan that doesn't work well for their situation," says Ohle. "When I counsel people on picking a plan, we sit down, look at what medications they are taking and the pharmacies they use. We then help them choose the right plan and determine the financial cost. In addition, if you are already enrolled, plans change yearly and the medications you are now taking may be different than when you originally signed up, so there may be a better plan for you."
Ohle advises seniors to get educated on all the different options and to seek expert advice from a trusted source when enrolling. The EJGH Elder Advantage program (454-4066) offers free counseling to all Elder Advantage members by appointment. Seniors also can contact the Centers for Medicare and Medicaid Services office (800-MEDICARE; www.medicare.gov ) or the New Orleans Council on Aging (821-4121).