Amidst confusion, consternation and excitement, Medicare is about to implement the biggest changes in Medicare in its 40-year history. Beginning Nov. 15, Medicare beneficiaries can start enrolling in one of the private plans providing prescription drug coverage under Medicare Part “D.” The new Medicare prescription option will take effect Jan. 1, 2006 for those enrolled by the end of the year. Medicare-eligible people have an open-enrollment period from Nov. 15, 2005 to May 15, 2006 to sign up for the new coverage. If they do not sign up and later decide to, they may face a premium penalty.

“While Part D Medicare Prescription Drug coverage is said to be “optional,” if seniors ignore these changes in Medicare, they do so at their peril,” said Howard Gochberg, co-chair of the Federation’s Medicare Justice Coalition. “If Medicare Part D had provided good, understandable and affordable prescription drug coverage, it would have been very easy to recommend that all seniors take out Medicare Part D, but we are faced with options that boggle the mind,” said Gochberg. All people on Medicare should weigh their options carefully before choosing a prescription drug plan or before deciding to opt out of the new coverage all together.

Who should take action soon? While for most people there is no reason to rush into making a decision about Medicare Part D before May of next year, two very important groups should make a decision by the end of December of this year:

• Seniors with low income and low resources who qualify for extra help paying for Part D prescription costs. ($14,355 single or $19,245 a couple and you have less than $10,000 single or $20,000 a couple in liquid assets) and
• ¥eniors with “catastrophic” drug costs (generally more than $5,100 of out-of-pocket prescription drug expenses annually).

These groups will clearly benefit from low-income and catastrophic coverage of Part D and should enroll before the end of 2005 to get full benefits for 2006.

“People do get daunted by a lot of choices. The MnSF Health Plan Information Center (651/783-5045 or 866/783-5045) and The Senior Linkage Line (800/333-2433) will provide seniors with Minnesota explanations of benefit options and help walk them through key factors when deciding what kind of coverage, if any, to select,” said Janine Stiles, MnSF Health Programs manager. (See related article on MnSF outreach efforts on page 5 as well as the 2006 Medicare Prescription Drug Plan Preview, a supplement to Health Care Choices for Minnesota Seniors, mailed inside this publication to Federation members.

“You listen to promotions from CMS and the administration, and it was the best thing since sliced bread,” said Robert M. Hayes, president of Medicare Rights Center, a group that helps seniors navigate Medicare rules and benefits. “And then you sit down with people and they say, ‘What do you mean - that’s all it is?’”

Hayes feels one-on-one counseling, not ads, will be the most effective way to educate seniors. “There’s a world of difference between ‘promotion’ and ‘education,’” Hayes said. “Almost all of the administration’s and drug companies’ efforts are promotional. Unless they throw more resources into one-on-one counseling, people with Medicare will be burned big time.”

Seniors don’t understand drug benefit. According to a USA TODAY/CNN/Gallup Poll released Oct. 4, most seniors don’t understand the new prescription drug program being offered under Medicare and don’t plan to sign up for coverage, even after months of community education by numerous advocacy organizations, state agencies and the federal government. The poll shows that 37 percent of respondents say they understand the program at least somewhat well, but 61 percent don’t. Those figures haven’t changed much from polls in July and August.

About one in four seniors say they plan to join the program, compared with 54 percent who say they don’t. Twenty-two percent have no opinion. The poll of 275 adults age 65 and older has a margin of error of + or - 7 percentage points.

“The (poll) numbers suggest an abysmal program,” says Hayes. “This benefit was designed to make it impossible for consumers to understand it.” Administration officials call the numbers encouraging given that specific plan information is just now being made available.

Beware of scams. The new Medicare Prescription drug benefit also, unfortunately is ripe for scams. Medicare Officials and advocates for seniors are issuing warnings about what might go wrong as private insurers increase sales efforts.

“While you’re checking out all the promotions,” Stiles cautions, “remember that there are some scams out there.” Remember:

• Signing up for a plan is free, so don’t let anyone charge you an application fee.
• You won’t lose your other Medicare benefits if you choose not to join a Part D plan: “If anyone tries to tell you otherwise, they’re wrong.”
• Never give out private financial information over the telephone unless you have initiated the call.

One concern about plans is selling directly to seniors.

“People should know that authorized drug plans are prohibited from selling products door-to-door and from sending unsolicited e-mails. They are also required to adhere to the federal Do-Not-Call registry and to honor consumers’ verbal requests to stop calling,” said Minnesota Attorney General Mike Hatch.

To sign up for the “State and Federal Do Not Call” lists, call 888/382-1222 (federal) and 800/921-4110 (state).

Hatch emphasized that consumers should understand that plans are not required to offer the same types of drugs. If a person needs a particular type of prescription drug, it is important to compare his or her needs against the list of drugs approved by the plans that person is considering. Additionally, there are likely to be significant cost differences among various plans that are available.

“If you are told of a plan that sounds too good to be true, it probably is. Make sure before you sign up that the plan is approved by Medicare and that it will cover the drugs and any other benefits that you need,” Hatch said.

If you think you’ve seen an incident of fraud, contact Medicare or your state’s attorney general.