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    Avoid making a Medicare D-Day mistake
City-sponsored health plans offer a better bargain
      

By John Perry

Senior and disabled citizens can enroll in Medicare’s new Part D drug plan.

But many are wondering if Part “D” stands for “difficult,” because of the sometimes-bewildering variety of options deluging their mailboxes.

“Confused, that what I was,” said Norma Turk, a retired nurse from Health & Human Services. “So much stuff came in, I didn’t even feel like reading it.”

On Jan. 1, Part D, Medicare’s prescription drug coverage, went into effect. The Centers for Medicare and Medicaid Services require Medicare Advantage plans to provide prescription drug coverage equivalent to, or better than, Part D.

However, if you join Part D, you will lose your Medicare Advantage plan coverage and not be able to return.

If you’re already enrolled in one of the city-sponsored health plans, the best advice for avoiding a D-Day mistake is to take a deep breath … stay put and don’t join.

“I was already enrolled in TexanPlus,” said Turk, 69. “And I was afraid I would have to change over to Medicare Part D.”

Why is this happening?
The U.S. Congress approved a new prescription benefit. In simple terms, Part D has the federal government paying a portion of the costs for outpatient prescription drugs. Millions of senior citizens can now get Medicare drug coverage by choosing from plans offered by private insurers. The enrollment period for this year started Nov. 15 and goes to May 15. After that, you would have to wait until Nov. 15 to enroll.

Some versions offer drug coverage only. Others offer a range of Medicare services, such as visits to a doctor’s office. Some options are a basic, no-frills plan with premiums averaging $32 a month. Some have higher premiums, but lower deductibles. Others will include more bells and whistles, but cost more in premium payments.

But with any of the Medicare Part D options, subscribers will pay some portion of the drug costs until their spending reaches $2,250. Subscribers then pay all drug costs up to $5,100. At that point, the subscriber pays 5 percent of any additional charges.

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Medicare timeline

— 1965-66
Medicare was created for the nation’s seniors. Coverage began in 1966.

Part A: Hospital insurance that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.

Part B: Medical insurance that helps pay for doctor’s services, outpatient hospital care, durable medical equipment and some medical services not covered in Part A.

— 1997-99
Part C: Beginning as Medicare + Choice, is now Medicare Advantage.

If entitled to Part A and enrolled in Part B, you are eligible to switch to a cost-saving Medicare Advantage plan provided you live in the plan’s service area.

— 2006
Part D: Effective Jan. 1, the outpatient prescription drug benefit begins.

 

Click here for a plan comparison of prescription benefits