Prescription drug plan
changes concern seniors
BY DAVE BENJAMIN
Staff Writer
Members of a citizens group are aiming to learn the details of changes in the federal Medicare Reform Act, particularly as they apply to prescription drug plans.
With recent changes in Medicare approved by Congress, senior citizens are looking ahead to 2006 when benefits will change. Some fear that will leave many seniors with a large gap in coverage.
Ed Walley of Manalapan, a member of the Concerned Citizens of Monmouth County (CCMC), and committee member Joseph Nass are examining the costs that seniors will have to pay in the near future. They discussed the matter with Greater Media Newspapers in an interview.
"This chart, provided by AARP (American Association of Retired Persons). indicates the premium will be about $35 per month or about $420 per year in 2006 for Medicare drug benefits," Walley said.
Walley said the plan is optional and no one is required to join.
Examining the coverage, Walley said the first $250 is a deductible.
"From $250 to $2,250 they will give you 75 percent back for drug costs," said Walley. "Then, what happens is known as the ‘doughnut hole,’ a coverage gap, from $2,250 to $5,100. You get nothing."
Walley said after someone’s drug bills reach $5,100-plus, Medicare will pay 95 percent of the drug costs and the senior citizen will pay a $2 copay for generic prescription drugs and a $5 copay for brand name prescription drugs.
He said he thinks there are some complications.
"If you’re going to buy this through a plan you better be sure that plan covers the drugs that you’re taking," said Walley. "Some plans don’t cover everything."
Another problem, he noted, occurs when a senior is part of a plan that provides excellent drug coverage, but is then asked why the plan should cover them when they can buy coverage from Medicare.
"You may lose what you have and [what you have] may be a plan with no gaps," said Walley. "This is the first time I’ve ever seen anything like this with a doughnut hole."
People with very high drug expenses may favor the plan, he said.
"A person with $10,000 in drug expenses might say that’s pretty good because it will give them back a lot of money. But if their expenses are $200 a year they’ll [probably] say who needs it," noted Walley.
Drug discount cards are now being offered, according to Walley and Nass.
"The drug discount cards primarily help low-income people," said Walley.
In an effort to provide answers to many questions regarding the prescription drug benefit (also known as Medicare Part D), Mada Liebman, senior adviser to U.S. Sen. Jon Corzine (D-NJ), held a seminar in April at the Monmouth County Library Headquarters, Symmes Drive.
Materials were distributed by Liebman which provided additional information:
• A national prescription drug discount card for Medicare eligible seniors was instituted in April. The cost will be $30 per year for the card and low-income seniors ($12,123 income per year) will be able to receive the card for free. That program will end on Jan. 1, 2006.
• It is estimated that as many as 94,000 New Jersey retirees will lose their employer-based prescription drug coverage. It will be up to the individual employer to decide whether it will continue to offer prescription drug benefits.
• This legislation cuts $552 million in reimbursement for oncology (cancer) drugs in New Jersey.
Other topics covered in the handout included: "How Do I Sign Up for the Benefit?" "Will This Legislation Affect Medicare Part B Deductibles?" and notes a provision that permits Americans to purchase prescriptions drugs from Canada if the Secretary of Health and Human Services certifies the safety of the practice.
"Each year there can be an adjustment to the plan," said Walley. "Many people are also fighting to have the doughnut hole either eliminated or reduced."
The information provided also noted that New Jersey seniors and providers will lose even more under the new bill.
• New Jersey hospitals will receive less than their fair share under the Medicare bill.
• Fewer seniors, 92,350, in New Jersey will qualify for low-income protections than under the Senate bill because of the assets test and lower qualifying income levels.
• The 220,000 New Jersey seniors who are currently enrolled in Pharmaceutical Assistance to the Aged and Disabled and Senior Gold will face disruption in coverage and will likely receive less drug coverage than they currently receive.
Additionally, it was noted that approximately one million New Jersey Medicare beneficiaries will see Part B deductibles rise faster than their Social Security benefits, and 51,980 New Jersey seniors will pay more for Part B premiums due to "means testing."
The Concerned Citizens of Monmouth County was organized in early 2004 by a group of residents. Its purpose is to present subjects of interest to residents in Monmouth County. It does not receive any funding, nor does it collect any dues, according to Walley and Nass.