How to navigate Medicare's new prescription-drug maze
Like millions of other Medicare recipients, Jeff Taylor, 43, had to
devise his own complicated combo to pay for HIV meds. Taylor’s
financial regimen included AIDS drug assistance programs, his own cash
and driving from his native Palm Springs, California, to Tijuana to
snag cheaper pills. Imagine his relief, then, when he heard about
Congress’ new, supposedly simpler Medicare prescription plan, which
kicked in January 1, 2006. But relief turned to horror when he tried to
understand it. The plan, called Medicare Part D, pays for meds through
hundreds of private drug plans. Plans vary by state, have different
premiums and cover different drugs, requiring nightmarish research to
find one that fits your needs. For months, Taylor has spent up to three
hours a day on the phone or Internet—and has yet to pinpoint his
out-of-pocket costs. Even benefits counselors remain baffled. “This
plan is so confusing some think that it might have been better if
Congress hadn’t passed a bill at all,” says Jeffrey Crowley, an HIV
expert at Georgetown University’s Health Policy Institute. “But for
some people with HIV, it is an opportunity to get better coverage.”
Here’s a primer.
Two-thirds of HIVers on Medicare are also
eligible for Medicaid—and before January 1, Medicaid covered their
prescriptions. Now Medicare covers them instead. Those eligible for
both who didn’t pick one of Medicare’s many new private plans by
January 1 were randomly assigned one. “Dual eligibles are the sickest
and poorest people with HIV who can’t afford to pay extra if they are
randomly assigned the wrong plan,” says Crowley. “People will fall
through the cracks. Even if it’s a statistically small percentage, that
is thousands of people.” Peter Ashkenaz, a spokesperson for the Center
for Medicare and Medicaid (CMS), says the government has taken
precautions to prevent this, but that any dual-eligible person unhappy
with the new regimen can find help at his or her pharmacy. For the
one-third of HIVers on Medicare who, like Taylor, aren’t dual-eligible,
enrollment in the new prescription plan is optional. Their enrollment
deadline is May 15—after which they’ll pay a penalty premium.
No
plan is permanent. Dual-eligibles can switch monthly and
single-eligibles at least once a year. What’s more, all plans cover
every antiretroviral (though not necessarily meds for side effects).
Can’t find a plan right for you? Crowley recommends dropping by
www.medicare.gov. Look at overall cost, including copays and drug
coverage. Or visit an AIDS service organization or benefits counselor.
Remember: Pick your plan—don’t let your plan pick you.
Find more info at the following:
Centers for Medicare & Medicaid Services www.cms.hhs.gov 877.267.2323
Medicare www.medicare.gov 800.MEDICARE
Gay Men’s Health Crisis Public Policy Department www.gmhc.org/policy.html 212.367.1000
