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The Dallas Morning News
WASHINGTON - With much fanfare, Medicare is about to begin its long-awaited program to help seniors struggling with costly prescription drugs.
Beginning June 1, lower prices will be available to beneficiaries who pay up to $30 annually for a Medicare-sponsored discount card. But there is a rub: Seniors will have to navigate a blizzard of sometimes confusing information to select a card.
"This is a population of aging Americans and people with disabilities. Will seniors, will 85-year-olds, will people with Alzheimer's be able to figure it all out?" asked Gail Shearer, a health expert at Consumers Union.
Health care companies will start hawking their Medicare-approved drug cards on Monday. When used at participating pharmacies, the cards are expected to yield discounts of 15 percent to 20 percent for specified drugs.
The voluntary card program was intended to provide temporary relief from rising drug prices when Congress enacted Medicare's prescription benefit last year. The cards will disappear when Medicare rolls out its broader drug coverage in 2006.
Introduction of drug benefits marks a new era for Medicare.
"The addition of this benefit is the most important change to the Medicare program since it started in 1965," said acting Medicare chief Leslie Norwalk.
But some lawmakers are worried about how seniors will like it and how much it will cost, especially when they think about the upcoming retirement of the 76-million baby boom generation.
Eager to make it work, Medicare has mounted a Herculean effort to educate seniors. The agency's Web site features a directory of card sponsors, drug price comparisons and other information. For those averse to the Internet, the agency added 1,000 service representatives to take calls on its toll-free lines.
"We are on track and ready to go," Norwalk said.
QUESTIONS & ANSWERS:
In a little more than a month, Medicare beneficiaries will be eligible for prescription drugs discounts if they sign up for a new drug card.
The Medicare-approved cards will be issued by private health care companies. They are intended to offer seniors some relief from soaring drug prices until Medicare's prescription drug coverage becomes effective Jan. 1, 2006.
Q. Who is eligible?
A. All Medicare beneficiaries, except those with outpatient drug coverage through Medicaid. The program is voluntary. You can sign up beginning May 3; discounts become available June 1.
Q. What do I do now?
A. Wait until May 3, when card sponsors begin marketing their programs. They will send out mailings that include application forms. Return the application form, and the sponsor will send you a card.
Card sponsors are listed by ZIP code on the Medicare Web site at www.medicare.gov.
Q. Can I sign up before May 3?
A. Medicare warns that anyone trying to sell you a card before May 3 is not an approved sponsor and is likely selling a fraudulent card.
Q. Who will issue the cards?
A. Nationwide, more than 30 private healthcare companies have qualified with Medicare to issue the cards. Many have familiar names such as Aetna and United Healthcare. Cards will also be available from less-known companies eager to cultivate consumer relationships.
Q. How do I know if I should get a card?
A. A card might help if you are paying full retail prices for your prescriptions or if your insurance does not meet all your drug costs. The card will be a significant help if you are eligible for the low-income credit.
The card will have less value if you already have drug coverage or if you receive savings through other cards, use other assistance programs or get prescriptions from other countries.
Q. How do I decide which card is best for me?
A. That is the tricky part.
Seniors will have to compare the drug discounts offered by each sponsor. A comparison will be posted April 29 on the Medicare Web site. Seniors should compare the sponsor's drug list, discounts and participating pharmacies.
Q. What if I am not comfortable using a computer?
A. Medicare can be contacted toll-free at 800-633-4227. AARP offers help at 888-687-2277. And drug card sponsors are expected to announce toll-free information lines.
Q. How much does a card cost?
A. Sponsors can charge no more than $30 annually for a card. But many sponsors will offer cards for less, with a handful promising $10 cards. Beneficiaries who qualify for the low-income credit will pay no card fee.
Q. How much can I expect to save?
A. Discounts will vary among the drug card programs. One industry survey projects an average 17 percent savings on brand name drugs and 35 percent on generics. Larger discounts may be available from mail order pharmacies. Prices will vary, as companies can change them weekly.
Q. Will all my drugs be discounted?
A. That is up to the card sponsor. Some will offer discounts on all drugs. Others might have a more restricted list but offer deeper discounts on the drugs they cover.
Q. Will the card be accepted at all pharmacies?
A. No. Sponsors will designate which pharmacies accept their cards. Some will offer mail order service. The cards cannot be used to buy drugs from other countries.
Q. What is the low-income subsidy?
A. It is a federal subsidy for single seniors who earn less than $12,569 in 2004, or married couples who earn less than $16,862. There is no means test for assets.
The subsidy pays 90 percent to 95 percent of drug costs up to $600 annually for 2004 and 2005. The $600 credit will be added to any Medicare-approved sponsor card. Any unused portion of the $600 for 2004 will be rolled over and added to the $600 credit for 2005. Some drug companies said they would give free drugs to low-income customers who use up the $600 credit.
Low-income seniors do not qualify if they have drug coverage from Medicaid, including state pharmacy plans that receive Medicaid funds. Those with group coverage, military or veterans health coverage, or the federal employees plan also do not qualify.
SOURCES: Centers for Medicare & Medicaid Services; AARP
(c) 2004, The Dallas Morning News. Distributed by Knight Ridder/Tribune News Service.