1-800-347-5297

Medicare Part D Help Available
from the Legal Hotline

Sarah Shearer, Hotline Part D Counselor
[download .pdf version]

The month of January not only brought in the New Year, it also brought about a big change to Medicare. As most people already know, Medicare is confusing enough when it comes to Part A (Hospital) and Part B (Medical). Now a new part, Part D, has been introduced.

Part D is a prescription drug program created by Medicare that allows private insurance companies to design drug plans for those on Medicare. In order to be eligible for Part D, a person must be enrolled in Medicare Part A, B, or both. The hard part is not determining eligibility, but determining when, where, how, why, and which plan to sign up for. Fortunately, Elder Law of Michigan, Inc. is available to help answer those questions through its Legal Hotline for Michigan Seniors (1-800-347-5297). This free service has been offering legal advice and information about the law to seniors in Michigan since 1990. Seniors call the toll-free number and schedule an appointment to speak with an attorney who calls them back in 1-2 days. Now the Legal Hotline has another way to help Michigan seniors: by providing in-depth counseling about the new Medicare D program.

The Hotline found that many folks have no idea where to begin in deciding whether to enroll in Part D. Some of the confusion arises from the large number of plans that are available to choose from---over 80 plans here in Michigan. One recent caller to the Hotline told the counselor that when she began looking at all of the plans she simply gave up because there were too many. The Legal Hotline does all the “leg work” to walk the caller through the various plans to see what plan will fit them best.

It is understandable to be nervous about a complicated new program that affects so much of your life. A frustrated woman called the hotline because she was told she had to sign up for a plan by May 15th or face a penalty. She did not want to sign up but was afraid she was going to be penalized for not doing so. After an explanation of the basics of Part D, a review of the various plans, and proof of how much she would save, the caller could not believe why people didn’t want to sign up! She cut her prescription drug costs in half, and all it took was a 45 minute phone call.

One special feature of Part D is called Extra Help. Extra Help is financial assistance to pay the yearly deductibles, monthly premiums, and co-pays for the various plans. Applying for Extra Help is free and eligibility is based on income and assets. It takes two to three weeks for the Social Security Administration to process the application and make a determination. A person might be eligible for Full or Partial Extra Help depending on their income and assets. If the person is on Medicare or Medicaid, they automatically qualify for financial assistance and should have received a letter from the Social Security Administration confirming eligibility. This shows up automatically when picking a plan.

Callers with questions regarding Part D are scheduled for an appointment to speak with a counselor. Then a packet of papers and a request to the client to gather information is sent out. The counselor needs the caller’s Medicare Claim Number and the effective dates for Part A and Part B along with financial and prescription information. Don’t worry about the safety of the information. All information is held confidential, and will be treated carefully and securely by the Hotline.

When the counselor calls she will be able to answer any questions, fill out the application for Extra Help, find the best plan for the caller, and enroll them in a plan. Using a computer to access the Medicare website, the counselor can accomplish all of this during the call.

The counselor has a thorough knowledge of the various plans and can present what options are available and help the caller make a decision. There are several reasons to make a decision to enroll:

1. to begin reducing the cost of monthly prescriptions right away;
2. since a plan does not immediately become effective---it will begin on the first day of the following month---it is important to get help with prescriptions as soon as possible;
3. most other prescription coverage through Medicaid and Medicare was only temporary and is no longer effective after January 1, 2006; and
4. to avoid the 1% per month increase in premiums that will apply after May 15, 2006.

If the caller already has some type of prescription drug coverage, and they sign up for a Part D Plan, that coverage will be eliminated. Insurance companies were required to send letters to policy holders that are Part D eligible stating whether or not their coverage meets the minimum standards provided by Medicare. If those standards are met, the individual does not have to switch and should hang onto that letter. If the standards are not met, the letter should have informed the client that they do need to join a Part D Plan.

When the counselor enters the client’s Medicare Claim Number along with other information into a database the process of choosing a plan begins. Medicare’s information on the client is applied to the information regarding the various Part D plans. The zip code identifies what plans are available in the particular area the client is living. Entering all of the client’s current prescriptions and their dosage provides a closer estimate of the actual costs that each plan quotes as a co-pay.

The counselor will ask about pharmacies in the caller’s area to narrow the search to plans that are accepted by that pharmacy. Pharmacies may have arrangements with certain insurance companies and only accept plans from them. Once the pharmacy is chosen, plans are carefully compared.

There are four costs to compare before picking a plan: the yearly deductible, monthly premium, co-pays, and the estimated annual costs. Finally, if a plan is chosen the counselor will use the information provided by the client to sign them up. Once the application is sent over the internet to the insurance company, the counselor receives the company telephone number and a confirmation number. Those numbers are given to the client for future use. The company will then send a card and more information regarding coverage to the client. The plan becomes effective the first day of the following month at which time the client can begin saving money on their prescriptions.

This may seem like a long process. But compared to the helpless and confused feeling of not knowing what to do, the phone consultation is simple and painless. The sense of relief that clients feel after they have the details for a plan and are all signed up is worth the time spent with the counselor on the telephone. The choice is much easier to make with the help of a counselor. The Legal Hotline has already helped many seniors and can help you.

Many callers are surprised about just how much they will be saving. One woman had drug coverage that ended January 1st, 2006. She had to pay for two of her prescriptions for the month of February because she had not yet chosen a Part D Plan. The cost for just those two prescriptions was over three hundred dollars and prevented her from buying three others that she could not afford to fill. She signed up for a plan that covered all five of her prescriptions for eighty-five dollars and her monthly premium was only forty dollars. Part D will save her thousands of dollars over this year. Call the Hotline for help that may save you some dollars as well.