What it means for you Under the new rules, Medicare plans takeeffect after a member has spent $250 on drugs in a particular year.From there, the plan pays 75 percent of costs until medicine expensesreach $2,250, after which seniors are on their own until costs reach$5,850. Plans available in West Virginia Standard, stand-alone planproviders: * Aetna Life Insurance Co. * American Progressive Life andHealth Insurance Co./Marquette National Life Insurance Co./Pennsylvania Life Insurance Co. * Connecticut General Life InsuranceCo. * Coventry Health and Life Insurance Co./First Health Life andHealth Insurance Co. * Highmark Senior Resources Inc. * HumanInsurance Co. * Medco Containment Life Insurance Co. * MemberhealthInc. * Pacificare Life and Health Insurance Co. * QCC Ins Co. D/B/AAmerihealth Insurance Co. * RxAmerica LLC * Silverscript insuranceCo. * Sterling Life Insurance Co. * Unicare * United AmericanInsurance Co. * United Health Care Insurance Co. * UPMC Health Plan *Wellcare Health Plans Medicare Advantage plans: * Humana Inc. *Coventry * Health Plan of the Upper Ohio Valley * Mountain State BlueCross Blue Shield Source: Centers for Medicare and Medicaid Services
mkelly@wvgazette.com
With less than two months left until West Virginia's seniorschoose their new Medicare drug plan, federal administrators revealedFriday the companies they can turn to for help.
But few details were given as to what help seniors would get inaffording the sizeable financial gaps in each plan's coverage.
Beginning Nov. 15, beneficiaries in West Virginia will have about19 standard plans from which to select. The plans begin Jan. 1 andall Medicare recipients qualify for the standard plans.
Four other plans will be available under Medicare Advantage, whichoffers more benefits and better co-pays, but also has certaineligibility requirements. Advantage-registered seniors can go to ahospital or doctor of their choice for an extra fee.
During a conference call with reporters Friday morning, Dr. MarkMcClellan, administrator for the Centers for Medicare and MedicaidServices, said competition among plan providers had resulted in lowerprices and better benefits than originally thought.
Indeed, CMS announced last month that the average premium is$32.50 each month, down from the earlier projection of $37 per month.Some plans would have a monthly premium under $20, the agency said.
According to the plan-provider list released Friday, only one plan- offered by Humana Insurance Co. - offers a plan that inexpensive.Furthermore, of the 23 plans available in Pennsylvania and WestVirginia, 16 have a monthly premium ranging from $30 to $35, and theaverage premium is a $32.78.
Of particular concern, however, is the so-called 'doughnut hole,'or the $3,600 gap in coverage for which seniors themselves areresponsible.
Under the new rules, Medicare plans take effect after a member hasspent $250 on drugs in a particular year. From there, the plan pays75 percent of costs until medicine expenses reach $2,250. Seniors areon their own until costs reach $5,850 dollars, after which Medicarepays 95 percent of drug bills.
A beneficiary could pay $3,850 each year for their medication.That's excluding the cost of premiums and co-payments during the timeMedicare is actually chipping in.
McClellan said Friday that options soon will be available throughCMS for seniors struggling through the gap, but he did not elaborate.
The Social Security Administration announced Thursday that about 3million people have applied for its low-income subsidy. The extraassistance will provide around $2,100 to low-income Medicarerecipients, including partial cost of premiums, deductibles and co-payments, according to the SSA.
The doughnut hole is just one of many concerns about the plans.
Consumer protection agencies fear that allowing plan-providerrepresentatives to cold-call seniors will make those seniorsvulnerable to scams.
Last month, CMS issued rules for selling plans, including banningdoor-to-door sales and unsolicited e-mails. Moreover, salesrepresentatives cannot ask for Social Security numbers or bankinformation, and, under federal law, can call only between 8 a.m. and9 p.m.
To prevent graft and pocket padding, health-care providers canprovide information on specific prescription plans and helpbeneficiaries choose the most beneficial plan, even if they have afinancial interest in a particular plan. However, they cannot leadseniors to a plan for sheer monetary gain.
CMS plans to survey benefit recipients on their experienceschoosing a plan, look into complaints and visit sites where seniorsare being registered or given information. People wanting to report asales company or other unsavory activity should call (800) MEDICARE.
Getting information to seniors also is a concern, particularly inrural areas such as West Virginia. In this state, local offices havetried to reach out through ads and call centers, in whichbeneficiaries can get an idea of the plans suiting their needs.
Help also can be had at West Virginia's State Health InsuranceAssistance Program by calling (877) 987-4463.
Next month, CMS will mail out a handbook and, soon after, havedetailed drug-plan information available on its Web site -www.medicare.gov - or through the toll-free number.
McClellan, on Friday, urged people to begin discussing theirMedicare plans as soon as possible.
'It's time for those with Medicare and those who care about themto start making choices,' he said. 'We want them to haveconversations about prescription drug plans.'
To contact staff writer Morgan Kelly, use email or call 348-1254.
