American Prepaid Legal Service Institute

Medicare Part D and a Great Source of Help For Your Clients

Medicare Part D is NOT the latest part of the Star Wars series, although, if you haven't been paying attention, it could be just as confusing. The newest prescription drug coverage plans for Medicare beneficiaries began enrollment on November 15, 2005 and began operation on January 2, 2006, to mixed reviews. Some legal service plan provider attorneys have been getting questions for months.

Plan Attorney and API President, Larry Stahl, says that he has seen a sharp increase in Medicare Part D questions. He recognizes that the demographic of the plans he serves has been getting older. He says that he is getting calls with questions both from plan members asking for themselves, as well as plan members who are asking for their aging parents.

An article in a recent AARP Bulletin states that there are a bewildering variety of choices. For example, eligible Alaskan residents may choose from among 27 different plans and that is the smallest number of any state. Some large urban areas such as Miami and Los Angeles have 99 and 83 choices respectively.

Digging through the choices and attempting to compare apples with watermelons while predicting future prescription needs has driven many people to contact their legal plan attorneys. Mr. Stahl says that his call volume on the issue has risen considerably. According to API Executive Director Alec Schwartz, plan lawyers facing "Part D" questions should have themselves or someone in their office be familiar with the www.medicare.gov web site. This site has some very useful tools which allow a person to find a prescription drug plan based on the actual drugs they are taking, the area in which they live and the pharmacies which accept a particular plan.

Unlike what you might expect at a government site, the clever folks who built this set of tools, did it with users in mind. You can look at summary information about plans in your state (or the state of your eligible clients or relatives) or plow ahead into getting specific listings based on a persons prescription drug list. For specific listings, following the site prompts to enter a Medicare claim number, last name and date of birth and ZIP, there is a choice of receiving general information about plans in the geographic area or more specific information which results if you choose to enter a list of prescription drugs.

Note that "Part D" coverage is complicated, involving deductibles, co-payments and a planned "gap" in coverage which kicks in after a certain level of plan reimbursements, after which reimbursement coverage resumes. According to the Medicare web site, for an average monthly premium of about $32, you get two levels of coverage: standard and catastrophic. After a $250 deductible, Medicare pays 75% of the cost of covered drugs until yearly costs reach $2,250. When yearly out-of-pocket prescription costs exceed $3,600, catastrophic coverage takes effect and Medicare pays up to 95% of drug charges for the rest of the year. Many plans will offer more coverage, smaller deductibles or premiums lower than $32. But those variations have to be factored in to the drug prices each plan works with, the specific amount the plan will pay at each level and the co-payment amount the covered person is expected to pay.

Mind-boggling? Yes. But fortunately the web site tools make all this information available before a plan is chosen. It is actually easier to understand how the drug plan will affect any given individual by plowing through the steps on the site than by trying to figure it out on your own. The result of the more specific search yields a set of results which allow you to compare plans by price, the cost of the drugs and the names and addresses of participating pharmacies.

This all may sound more complicated than it is. Once someone gets the hang of the web site, it is not difficult to help a person make a good choice of plan. If a person surfs the web regularly and is accustomed to filling out the forms needed to purchase something on-line, they should be able to used the Medicare web site. If not, someone in your office could be there to help.