YOUï¿½VE PROBABLY DEVOTED far too much time over the past few months trying to sort out Medicareï¿½s new Part D prescription-drug benefit. Think of it as carefully plotting, scheming and cajoling to get tickets for the opening of a long-awaited Broadway show. Now, the curtain is risingï¿½25 months after a controversial three-hour vote in the House of Representatives to okay the biggest expansion of Medicare benefits since the program was created four decades ago. So itï¿½s time to shift your thinking from ï¿½How in the heck do I choose a plan?ï¿½ to ï¿½How in the heck does my drug plan really work?ï¿½Weï¿½ve asked an array of expertsï¿½Medicare officials, insurance- and drug-industry sources, consumer advocates, and providersï¿½for answers to questions youï¿½ll likely be asking in the weeks ahead. First off, two trends retirees will see in the months ahead:
Second-guessing. ï¿½A lot of beneficiaries lured into a
PDP [prescription-drug plan] by promises of low
premiums may be shocked the first time they go to
the pharmacy and have a high co-payment,ï¿½ says
John Gorman, a former Medicare official who now
runs Gorman Health Group. Whether youï¿½ve fallen
into such a trap or discover other shortfalls with your
plan, most beneficiaries get a free do-over, the opportunity
to switch plans one time before May 15.
Remain flexible. ï¿½Thereï¿½s no doubt this market will
be radically different at the end of 2006 than it is
now,ï¿½ says Robert Hayes, president of the Medicare
Rights Center. Some plans are likely to flee; others
will change their pricing and benefits structure.
Meanwhile, Congress could make changes the program.
The result: Thereï¿½s a good chance youï¿½ll need
to reexamine your options later this year.
A Quick Part D Recap
Medicareï¿½s voluntary Part D prescription-drug benefit
started January 1. Beneficiaries with coverage considered
to be as good as or better than the new Part D
benefitï¿½either through a former employer, union or
other meansï¿½should not enroll in Part D. All other
beneficiaries probably should. Most retirees have
until May 15 to do so. Failing to enroll in Part D by
that time will trigger a 1% premium penalty for each
month you dally. The program requires you to spend
$3,600 out of pocket before you hit so-called catastrophic
coverage, with Medicare paying 95% of subsequent
drug costs. Now, answers to the questions
that are bedeviling beneficiaries.