Medicare Part D help available

Kit Sherfey is a retired accountant, which means he’s got the time and expertise to take on the government’s prescription drug plan, Medicare Part D.

But even Sherfey was reduced to furrowed brows and muttered complaints last week as he clicked his way through www.medicare.gov in his Spokane basement.

“Walking through Part D is like walking through a minefield with lots of booby traps,” said Sherfey.

At 60, Sherfey’s not old enough to sign up for the drug plan accessed by more than 38 million Americans since the program began Jan. 1.

But his wife, Karen Sherfey, 66, is among more than 1 million people in Washington and Idaho who are eligible to start or change drug plans when a new enrollment period begins.

From Nov. 15 to Dec. 31, clients will consider nearly five dozen prescription drug plans available in Eastern Washington and North Idaho, trying to figure out the mix of coverage, price and protection that suits them best.

On average, consumers will be able to choose from more plans covering more drugs for about the same price – $24 a month for people who stick with their current plans, federal Medicare officials said.

But there’s nothing average about Medicare Part D, which is as individualized as a government program can get, said Todd Myers, spokesman for MedicareRx Access Network of Washington, a state affiliate of a national group that offers sign-up and other assistance.

“Everybody’s so different; husbands and wives rarely have the same plan,” Myers said.

Across the Inland Northwest, some premiums for the most popular programs are up this year. A low-cost Humana premium in Washington increased from $7 to $15 a month; a popular program with enhanced coverage went from $51.17 to $78.10.

About three-quarters of those who could sign up for Part D last year did so, totaling nearly 623,000 people in Washington and about 143,000 in Idaho, according to Medicare officials.

No one knows how many of them will want to switch plans or how many will enroll during the six-week sign-up period that ends Dec. 31, said Michael Marchand, director of public affairs for the regional Medicare office.

About 80 percent of Part D enrollees said they were satisfied with their plans, according to several surveys, Marchand said.

Local workers at SHIBA – Statewide Health Insurance Benefit Advisors – agree, but they expect no shortage of phone calls and visits as clients grapple with the complicated and often confusing process.

“I think it’s going to be easier because so many people have already been through it,” said Leslie Noll, Medicare specialist with Aging and Long Term Care of Eastern Washington. “Last year it was just so big and so scary.”

While it’s not possible to offer specific advice about the right plan for every individual, there are general guidelines that will make enrollment easier this time around.

The Spokesman-Review talked to experts, volunteers and clients to come up with answers to the most common questions about Medicare Part D.

Q:Do I have to sign up for the prescription drug program now? What happens if I don’t? How often can I change plans? And can I drop out of Part D if I don’t like it?

A:No one has to sign up for the drug program, but people age 65 and older can if they choose. The once-a-year enrollment period is held Nov. 15 to Dec. 31 for coverage that begins Jan. 1, 2007. That’s the only time that people can change plans or drop out of coverage. Those who didn’t sign up when enrollment began last year will pay a permanent, cumulative penalty of 1 percent a month of the average premium. By next year, that penalty will be 19 percent.

Q:Where do I go to sign up?

A:Starting Nov. 15, you can log onto www.medicare.gov to sign up for Part D benefits or to change your plan. Before that date, you can plug information about the drugs you take into the Web site’s plan finder and see what your options are.

When you plan to enroll, come prepared with a few necessary documents:

•Your Medicare Part D drug card;

•A complete list of all the drugs you take, including the specific doses;

•Information about how much you can afford to pay per month;

•If you’re changing plans, make sure to have specific details of how much you spent before, how much the drugs cost and when you entered the so-called Medicare “doughnut hole.”

Q:What’s that?

A:The “doughnut hole” is a gap in Part D coverage that requires clients to pay for their own drugs. In 2007, clients had to reach $5,100 in drug costs inside the gap. In 2007, that amount has increased to $5,451.25.

This year, the gap generally works like this: After an initial $265 deductible, Medicare pays 75 percent of drug costs until they reach $2,400. After that, clients pay 100 percent of drug costs until total out-of-pocket expenses rise to $3,850. Some plans cover costs inside the gap, mostly for generic drugs.

Q:How do I know which plan to choose? Can’t I just pick the cheapest premium and leave it at that?

A:The monthly premium is only one of several elements to consider when picking a plan. It’s also important to look at what drugs the plan covers, how much the provider charges for them and whether the drugs are available by mail, which can be far less expensive than a walk-in pharmacy.

Choosing a plan by premium alone is like buying a car based only on gas mileage, said Kit Sherfey, the accountant who has studied Part D. It’s just as important to consider the overall cost of the car.

Q:If I sign up or switch plans, can I still take the same drugs?

A:That depends. Many plans offer far more selection and coverage of generic drugs rather than brand-name drugs that some doctors specify. It’s important to understand whether the drugs you take come in generic form, and whether it’s OK if you take them instead.

Talk to your pharmacist or your doctor about the drugs you take. In some cases, your doctor can submit an appeal to have name-brand drugs covered.

Q:I think I’ve found the plan that’s right for me. How can I be sure?

A:Take your plan for a test drive before you make a final choice. Call the customer service line. See how long it takes for them to answer the phone; notice how helpful the person who answers seems. Ask the company about their policy on generic drugs. Ask about their appeal process.

“The most important thing is to call the plan and see how they relate to you,” Noll said.

Q:Where can I get help?

A:There are a wide range of sources for assistance. First, try your computer-savvy friends and family. Sherfey signed up his wife and several of the women at her church. Noll signed up her neighbors.

You might see Part D information sessions sponsored by other agencies as well, and by insurance companies. While the information might be valuable, Noll and others caution that the insurance companies are seeking clients.

“Understand that they have a vested interest in this,” Noll said.