Officials explain Medicare programs

Richard Perea explains the new Medicare Plan D prescription drug benefit to Henry and Mary Hands at the Parkhurst Pharmacy in Grants Tuesday afternoon. Seniors have until May 15 to sign up for the new drug plan without penalty. In order to qualify, applicants must be on Medicare plans A and B first. [Photo by John A. Bowersmith/Independent]

By Jim Maniaci
Cibola County Bureau

GRANTS — The first day elderly Americans could sign up for the massive drug assistance plan of the federal government was Tuesday, the day Second District Congressman Steve Pearce, R-N.M., sent two staff members to Grants to explain its complexities.

About 50 men and women filled the meeting room of the Cibola Senior Citizens Center in Grants to hear them and a regional federal director of the Health-Human Services Department go through the steps such as those who sign up by Dec. 31, can receive help in paying for their medications as of Jan. 1. Those who are eligible to sign up but don't do so by the May 15 deadline will be permanently penalized 1 percent per month for their tardiness.

Since private vendors are supplying the insurance, the county's senior citizens have a wilderness of options and choices.

Ron Morsbach and Barbara Romero of Pearce's field staff in Socorro joined with Dallas Regional Director Linda Penn of the H-HSD in taking turns answering questions and offering ideas, such as putting all the necessary papers into a 3-ring notebook binder as soon as they are received.

Penn called the Medicare Part D prescription medicine plan the biggest change in Social Security's history since Medicare began.

"Seniors have been asking, 'give us a fair price in our coverage, like you do with the doctors and hospitals (Medicare Parts B and A).' But each individual is different," she said. To be fair, the Part D meets the individual needs by offering various options.

She compared it to buying auto insurance, indicating Cadillac coverage wouldn't be needed for a small Chevrolet sedan, or a recreational vehicle or an 18-wheel semi-tractor-trailer.

"There are a lot of plans; it's very competitive," she said in urging people to study carefully the premiums, deductible charges, co-payments and the formulary which is the list of prescription drugs which that particular insurance plan's option will cover.

A nice feature about Part D, she said, is that there are an unlimited number of co-payments, the charge to the patient for each prescription.

Another feature of interest is that if grandparents have the actual physical responsibility of raising the grandsons and granddaughters which is a suprisingly common occurrence that counts towards the size of the family household calculations. The speakers also explained the greatly reduced prices for those with incomes below the federal poverty levels.

If people have company or government insurance for prescriptions, which is better than the Part D, then they are exempt and no penalty would apply until they reach the covered status, such as when they no longer have that non-D coverage.

Under Part D, the customer will pay the first $250 each year. From $251 through $2,250 in prescription costs the customer will pay one-fourth and the insurance company three-fourths. From $2,251 to $5,100 the customer pays the full bill. This is known as the doughnut hole. From $5,101 and up the customer pays 5 percent. In addition, the insurance company will charge a monthly premium, depending upon how many drugs are in the formulary of the option the customer selects.

Morsbach gave Cibola Senior Citizens Center Manager Dorrie Sandoval a sheet to share with interested senior citizens showing the New Mexico-approved 17 companies and their 43 options with the monthly premium.

Most companies offer three tiers with each step up covering more drugs at a higher price. The sheet also indicates the deductible level, co-payments, additional coverage and the number of covered drugs among the top 100. Of the 17, all except one allows mail-order service.

— To contact reporter Jim Maniaci, telephone (505) 285-6184 or (505) 870-7775 (cellular).