If you wanted to mix up a medication to encourage procrastination, a dose of Medicare Plan D might just do the trick.
Take a jigger of medical jargon, a cup of complexity and a deadline that hits each year on New Year’s Eve.
“People don’t like to do this. It’s just a hassle,” said Sue Bailey, program manager for the Yellowstone County on Aging Resource Center, which helps seniors apply for the Plan D financial help to buy prescription drugs.
Only true procrastinators are still sorting through the 46 plans offered in Montana. If you fall into that camp, here are some tips.
At this late date, applicants should call a private insurance company or Medicare directly at 800-633-4227 or 800-MEDICARE. Or they can go online at www.medicare.gov.
Ideally, Plan D users should compare plans and apply every year because insurers often change which drugs they cover and because drug costs keep rising. Open enrollment started Nov. 15 and ends at 9:59 p.m. MDT on New Year’s Eve, or a minute before the start of 2010 on the East Coast.
However, more Montanans seem to be running the Plan D gantlet every second year, Bailey said.
“2009 was kind of quiet, but I’m expecting 2010 to be really busy,” she said.
The four full-time employees and one part-timer at the Resource Center had completed 544 face-to-face appointments by noon Tuesday. The nonprofit still expects to top the 700 applicants seen last year.
In Montana, premiums range from $23 to $104 for the Plan D coverage that starts Jan. 1.
Even if you ran the numbers in the fall, you still should double-check them before actually enrolling.
“We’ve had a lot of situations where people have changed drugs or dosages. That can completely change which plan is right, and the drug costs can change daily without notice,” Bailey said.
That’s what happened to Pam Farmer, who signed up her mother, Viola “Vi” Farmer, for another Plan D provider Tuesday. The premiums had gone up significantly on her mom’s current plan and it covered less, so they switched.
Pam Farmer, who works in mental health at the Billings Clinic psychiatric center, said she’s grateful that the Resource Center assistant was able to quickly run the comparisons.
A person normally cannot choose another Plan D option mid-year even if medications change and the new drugs aren’t covered. But you can ask your doctor to intervene and tell the company the drug is medically necessary.
“Generally, when it is medically necessary, the company will make an exception for the rest of the year,” she said.
Some exceptions are made to the Dec. 31 deadline.
People who have moved into this Plan D region from another area have 63 days to change insurance carriers, and folks who enter or leave a nursing home can enroll again.
People who enroll at the last minute may end up paying full drug prices until their new membership number arrives. In this case, the person can give the pharmacist the telephone number of the current Plan D company and the pharmacist can call to get the membership number.
If the full price is charged, the buyer should save the receipt and resubmit it within 30 days. The pharmacist can rerun the prescription and capture the Plan D savings. That’s extra work for busy pharmacists, but it is an option, Bailey said.
Even generics aren’t always cheap anymore.
“Just because it’s a generic doesn’t mean it costs $10. I’ve seen generics that cost $110,” Bailey said.
In addition to Plan D, low-income people can ask Social Security to help pay for medications. To qualify, a single person can make no more than $16,248 per year and have assets of $12,510 or less. A couple can earn $21,852 per year and have assets of $25,010.
Low-income Montana residents also can turn to Big Sky Rx for extra help in paying the premiums for Part D coverage.
Having a Dec. 31 deadline is a problem because of the busy holidays and the winter weather, Bailey said. She would like the deadline moved up to Nov. 31.
“We’d have the extra month of December to get the information out and to catch mistakes,” Bailey said. “And it’s just not logical that you can enroll in a plan on the 31st (of December) and expect that coverage to start Jan. 1.”
Contact Jan Falstad at email@example.com or 657-1306.