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New Medicare Plan Explained to Residents

Oct. 28, 2005 — A new plan designed to assist seniors with prescription drug costs will soon be available to individuals with Medicare health insurance, according to Kitichia Weekes, director of the V.I. State Health Insurance Assistance Program.
Weekes spoke about the plan, as well as other Medicare changes, at a forum held Thursday at the Holiday Inn Windward Passage Hotel. As was the case on St. Croix earlier this week, the forum on St. Thomas was well attended, drawing at least 200 Medicare recipients.
Weekes said the plan will go into effect on Jan 1. 2006, but V.I. residents eligible for coverage may sign up between Nov.15, 2005 and May 15, 2006. If individuals choose to enroll after that date, a penalty will be added to their insurance premium. The charge will be 1 percent monthly for every month after May 15 that an individual didn’t enroll, Weekes said.
However, seniors with other prescription drug coverage will not have to pay the penalty if they decide to enroll after the May cutoff date. Weekes said in this case people would simply have to check with their insurer to see whether their coverage is as good as or better than that offered by Medicare, and they will be eligible to participate in the program.
Once enrolled, coverage can be provided through two private companies — MemberHealth, which is offering its Community Care Rx Plan, and United Health Care Insurance, which is offering its AARP Medicare Rx Plan.
Under MemberHealth’s Plan, individuals have three coverage packages to chose from—basic, choice, and gold. The monthly premium under these plans range from $32.06 to $44.01, with deductibles (the amount of money a person has to pay out of pocket before starting to receive insurance coverage) ranging from $100 to $250. Individuals under this plan can have prescriptions filled at the Kmart pharmacy.
Under the AARP Medicare Rx Plan, the monthly premium is $29.55, with no deductible. However, Weekes said the plan also has an "insurance gap," meaning the insurance will cover the first $2,250 an individual spends on prescription drugs. After that point, the individual has to spend another $3,600 out-of-pocket before coverage begins again.
Individuals under this plan can have prescriptions filled at Doctor’s Choice Pharmacy on St. Thomas, and Chelsea Drug Store on St. John.
Co-pay for generic, non-preferred brand name, and preferred brand name drugs are also included in both plans, ranging from $4 to $56 based on the type of drug needed.
In order to choose the best plan, Weekes said seniors must consider how much income they earn, the type of insurance coverage they currently have, which medications they take, and what pharmacies are closest to them.
"It’s really best if you consider everything before making a decision," Weekes said.
She said that extra help will be available through the local Medical Assistance Program for lower income residents who have trouble paying the premiums. Those who do not qualify for this program may also get help with prescription costs through the Department of Human Services’ Pharmaceutical Assistance Program.
At Thursday’s forum, Weekes urged seniors to call the offices of the agencies in order to pick a plan that is suitable for them.
Also speaking at the forum was Maria Martinez-Sanchez, interim manager of the Center for Medicare and Medicaid Services (CMS) in Puerto Rico, who told seniors about other changes taking place under the Medicare policy.
Martinez-Sanchez said for those with Part B coverage (medical insurance), CMS will now be offering education and counseling about preventive services, as well as an overall health examination, cardiovascular screenings, and diabetic screenings.
Those with Part A coverage (hospital insurance) will, however, be seeing an increase in Medicare deductibles and co-insurance pay. Starting Jan.1, 2006, an individual who is hospitalized for a 60-day period — no matter how many times that individual is admitted or discharged from the hospital during the 60 days — will have to pay $952. This is in comparison to the current $912 deductible.
A $238 daily co-pay will be applied to those hospitalized for 61 to 90 days, while a $476 daily co-pay will be applied to those hospitalized from 91 to120 days. After that, insurance coverage will cease.
Monthly premiums for those with either Part A or Part B coverage, or both, will also increase from $78.20 to $88.50.

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