The Perfect (Prescription) Plan

The Perfect (Prescription) Plan

Help is available for Virginians who must choose from 53 options for Part D.

Fifty three plans, three and a half weeks. Virginians who want to enroll in a Medicare Part D prescription drug plan for 2007, or switch from the plan they had in 2006, must choose from a “mind-boggling” array of options by Dec. 31, or wait until 2008, according to Sherri Gillam, a mental health manager with the Fairfax-Falls Church Community Services Board. “There’s so many factors to consider,” she said, including the cost of premiums, formularies (the drugs available for each plan) and fine-print restrictions. “It’s really a pretty complicated process.”

Last year, the federal government’s help lines were jammed for hours, Gillam said, as people on Medicare tried to negotiate a new system with an unwieldy Web site. To make sure their own clients could enroll, the CSB assigned some of its staff members to learn the intricacies of the program and meet individually with clients to help them sign on. The effort was a success, Gillam said. CSB staff enrolled 1,320 people in the community, including 92 percent of the clients in its system who were eligible for it.

This year, the CSB is expanding its effort to help people in the community find which of the 53 programs available to Virginians is right for them. Anyone who is already on Medicare, because of age or disability, is eligible for the Medicare Part D prescription drug service.

Besides holding individual appointments as they did last year, the CSB is trying to reach out to as many people as possible by holding drop-in sessions across the county, staffed by counselors from different agencies who can advise applicants on every aspect of the process, including finances, convenience, and payment subsidies. People who come in with their Medicare card and information on all their prescriptions, including the full and exact name, milligram dosage and number of pills taken each month, will be able to walk out enrolled in a plan.

For people in the Richmond Highway area, the CSB’s drop-in session is scheduled for Tuesday, Dec. 12, from 10 a.m. to 4 p.m. at the South County Government Center, 8350 Richmond Highway.

Because of the confusion that attended the program’s debut last year, Medicare held open the enrollment period for three months and added staff to man the advice hotline (1-800-MEDICARE) 24 hours a day, Gillam said. This year, with an improved Web site, the process is expected to go more smoothly, so only six weeks were allocated for enrollment, beginning Nov. 15.

People who want to keep their existing plan do not need to do anything, Gillam said. But she recommended that everyone double-check their plan to ensure it there have been no changes that will affect the prescriptions they need. The changes to many plans, including some dropping out and new ones being added, influenced the CSB’s decision to offer help again.

This year special plans will be available that will cover the cost of some drugs when a client is caught in the dreaded “donut hole,” a gap in coverage that occurs when people’s prescriptions cost more than $2,400 a year but less than $5,450. With traditional Medicare Part D plans, anything in between, up to $3,850, must be paid out of pocket. “Enhanced plans,” which will have higher premiums, will cover 75 percent of the cost of generic drugs regardless of whether the client is in the donut hole or not, said Mari DeLeon, one of the CSB’s healthcare access specialists who’s been trained to guide people through the Medicare enrollment process

DELEON SAID that even people who get the major information right may still overlook restrictions in the fine print, such as quantity limits, pre-authorizations demands that require the doctor to send a letter to the insurance company and “step therapy,” which requires patients to try a generic drug and document that it didn’t work before being allowed to take a more expensive name brand drug. “There are so many underlying factors. It’s not a simple choice to make,” DeLeon said.

And the problem is often exacerbated by the need to enter this complex information into a Web site. “A lot of the older adults aren’t necessarily computer savvy and that’s why we’re offering this assistance,” DeLeon added.

Gillam said the CSB has six counselors working full-time on Medicare enrollment. She hopes the outreach efforts will mean that more people will get help with their enrollment. “We’ll help anybody who walks in and we encourage people to really think through their choices very carefully. We’re there to really help them evaluate their choices.”

Gillam encouraged people to enroll as soon as possible. Processing can take several weeks, so requests made at the end of December may not be in place by Jan. 1.