The May 15 deadline for seniors to sign up for the new Medicare Part D prescription drug benefit is history. As of early May, about 71 percent of Minnesota Medicare beneficiaries had drug coverage (503,197), leaving about 200,000 without drug coverage. What does it mean for seniors who have enrolled and for those who haven’t? The three big initial winners in Minnesota are BlueCross BlueShield, United Health Care (and the AARP products) and Humana who have captured about 80 percent of the Minnesota Medicare prescription drug plan market. Whether or not you enrolled with one of these three providers, or any of the other 25 companies offering coverage in Minnesota, there are several important items to keep in mind.

For persons enrolled - coverage

There are vast differences in coverage throughout the 67 plans offered in Minnesota. Many, but not all, have a $250 annual deductible. Some, but not all, have a 25 percent co-pay for the next $2,250 worth of covered drug costs, and most, but not all, provide no coverage, except for plan-negotiated discounts, in the “donut hole” when your out-of-pocket drug costs are between $2,251 and $5,100.

Bruce Stuart, executive director of the Peter Lamy Center on Drug Therapy and Aging, estimates that before the end of this year, 38 percent of Medicare Part D enrollees will be subject to the “donut hole,” and 14 percent will exceed the threshold of catastrophic coverage.

It is important that you understand your coverage and its limitations and to look at alternatives to hold down your overall prescription drug expenses. Call your prescription drug plan or the Federation’s Health Plan Information Center (651/783-5045) to make sure you understand details of your coverage. Also be sure to use the money-saving ideas discussed in the box at the end of this article.

For persons enrolled - formularies

In addition to coverage, remember that your plan has a drug formulary - a listing a specific drugs that are covered by your prescription drug plan. Plans can change formularies under certain circumstances such as if a generic equivalent becomes available for a brand-name drug or if there are safety concerns. If the drug you are taking is not covered, check with your doctor to see if other drugs that treat the same condition might work for you. If you need a particular non-formulary drug for medical reasons, talk to your doctor about filing an exception for you. If approved, that non-formulary drug will be covered at least for a period of time.

For persons enrolled - participating pharmacies

Make sure the pharmacy you want to use is participating with your Medicare drug plan. If they are not, but are willing to, request that they become a provider in your plan or talk with your plan to find another pharmacy close to you.

For persons enrolled - locked in

If you enrolled, but are not eligible for the low-income Extra Help, you are locked in to both the company and the particular plan you have enrolled in until the end of 2006. Rules are more lenient for low-income persons who qualify for Extra Help for Medicare Part D (see page 5). However, you can change plans to improve coverage, regardless of your health condition, during a Nov. 15-Dec. 30 open-enrollment period. If you change plans during this period, your new coverage starts Jan. 1, 2007.

For persons enrolled - problems with your drug plan

If you are experiencing problems with your Medicare prescription drug plan, first try to resolve the problem with your plan. Their customer service number is with their plan materials and is most likely on your Part D membership card. If that does not resolve the issue, contact the Senior Federation’s Health Plan Information Center for an explanation on how to appeal a plan decision, 651/783-5045 or toll free 866/783-5045.

If you did not enroll in Part D

If you did not enroll in Medicare Part D (through a stand-alone drug plan or a managed care plan) or have creditable drug coverage through another source, you cannot enroll for Medicare prescription drug coverage until Nov. 15. As it currently stands, with few exceptions, if you were eligible but did not enroll in Medicare Part D before May 15, you will face a 7 percent premium penalty (initially about $3 a month) if you take out coverage for the first time in 2007. 

But take heart, momentum is building to potentially eliminate the financial penalty for people who sign up during the Nov. 15-Dec. 30, 2006 open-enrollment period. The Senior Federation and Medicare Justice Coalition are actively calling for the elimination of the penalty (see page 6).

Rep. Nancy Johnson (R CT-05) and Minnesota Rep. Jim Ramstad are co-sponsoring legislation that would not charge a penalty for persons enrolling for the first time during the next open-enrollment period (Nov. 15-Dec. 30, 2006). “While I am pleased that so many seniors have signed up for this important new benefit and are already saving money, I’m convinced that the complexity of the program and the early implementation problems make it necessary to give seniors more time to enroll,” said Ramstad.

“This benefit can help seniors save money on their prescription drugs and I don’t want to see seniors penalized because they did not have the time or resources to enroll by May 15,” he added.

If you are among the approximately 200,000 seniors in Minnesota without prescription drug coverage, click here to look at money-saving ideas, check out the Spring 2006 edition of Health Care Choices for Minnesota Seniors (available free to members by calling the Senior Federation and others for a postage/handling fee), call the Federation’s Health Plan Information Center (651/783-5045) or check the Federation’s website at www.mnseniors.org.