State Senator Leticia Van De Putte, District 26

For Immediate Release
February 2, 2006

OP-ED

Medicare's New Coverage for Prescription Drugs: What You Need to Know

As of January 1, 2006, Medicare began offering insurance coverage for prescription drugs, through the federal Medicare Part D program. As a pharmacist for 26 years, and a State Senator, I recognize the importance of educating my friends, family, and neighbors on this change in prescription drug coverage. Therefore, before the implementation of the program, I joined the Alamo Area Council of Governments (AACOG) and the United Way in holding an information session about the program.

On January 1st, the Texas Medicaid program discontinued paying for prescription drugs for individuals who were considered "dual eligibles" (persons who are entitled to Medicare, Part A and/or Part B, and who are also eligible for Medicaid). Due to the problems with the implementation of the program, the Texas Health and Human Service Commission reactivated Medicaid prescription drug coverage for dual eligibles who are inappropriately denied under Medicare Part D.

Dual eligibles who did not enroll in a plan as of December 31, 2005, were randomly placed in a plan effective January 1, 2006. Those who have been enrolled in a plan that does not meet their prescription needs can make changes in coverage by enrolling in another plan. Dual eligibles have until May 15, 2006, to make these changes by calling 1-800-MEDICARE or by going on-line to www.medicare.gov.

Individuals who are not considered dual eligible can actively enroll in a Medicare prescription drug plan which meets his or her needs. It is vital that individuals choose a plan with a formulary that covers their prescription drugs. Enrollment has already begun and will continue through May 15, 2006. Joining a Medicare prescription drug plan after May 15, 2006, will likely mean paying a higher monthly premium, which must be paid as long as the enrollee participates in a Medicare prescription drug plan.

During the initial enrollment period, individuals eligible for Medicare Part D should take time to research their current prescription drug coverage. The first step individuals should take to determine whether to enroll in the program is to call their current health insurance provider to find out if their current prescription drug coverage is "creditable". "Creditable" is defined as having prescription coverage as good as or better than what Medicare Part D can offer. If an individual's prescription drug coverage is "creditable," then the Medicare Part D prescription drug program is probably not the best option.

If the current prescription drug coverage is "not creditable," the next step is to determine which Medicare Part D plan is most suitable. Representatives are available at AACOG to assist individuals in determining the best plan. Prior to calling an AACOG representative, it is recommended that an enrollee have his or her Medicare card accessible, the names of the prescription drugs that are used, dosages and the daily quantity. Since the available plans have different formularies and cover different prescription drugs, calling an AACOG representative is a great option, allowing individuals to receive one-on-one, personal attention. AACOG representatives can be reached at (210) 362-5000.

It is important to note that even if an individual does not use prescription drugs now, he or she may in the future. Therefore it is important to consider joining. Similar to private insurance, there is a monthly premium (the average monthly premium for 2006 is estimated at $37) and a yearly deductible (up to $250 in 2006). Other than the monthly premium, most plans require a co-payment. AACOG representatives can help determine which plan covers most or all of an individual's prescription drugs and which plan is economically suitable.

For individuals who require economic assistance, a free application can be filled out at the local Social Security Administration office or it can be completed on-line at www.ssa.gov. The information on the application will determine if one qualifies for "extra help" in paying for the prescription drug coverage. It is estimated that millions of individuals will qualify for a Medicare prescription drug plan with little or no premiums or deductibles, and low co-payments.

I want to emphasize how crucial it is to be informed on these changes in prescription drug coverage, therefore allowing everyone to make the choice that is right for them. These changes can certainly be confusing so please take advantage of all the resources available. Ultimately, the Medicare Part D prescription drug program is important for better health and a good quality of life. We must remember our health is our most precious gift and because we love and cherish our Senior Citizens making the right decision on this program will have great consequences for all of our families.

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