Originally created 11/10/05

Answers on prescription drug plan don't satisfy all

Mike Leavitt came to Augusta to help answer questions Wednesday about Medicare's forthcoming prescription drug program.

Mary Leach, 94, is not so sure he answered hers.

"Some of them were answered, and some of them ain't been answered," she said at St. John Towers after going toe-to-toe with Mr. Leavitt, the secretary of the U.S. Department of Health and Human Services, which oversees Medicare.

Mr. Leavitt, 54, held a town-hall-style meeting to answer questions about what is known as Medicare Part D, in which Medicare recipients can enroll, starting Tuesday, with private insurance companies for prescription drug coverage beginning Jan. 1.

Mrs. Leach, who said she gets her only prescription free from her doctor, wanted to know why she should bother.

"I'm very healthy," Mrs. Leach said. "Should I buy it?"

The answer is yes, Mr. Leavitt said, because Medicare recipients may need more drugs in the future. And after the initial enrollment period ends May 15, the cost of the plans increases about 1 percent per month for new enrollees, he said.

"So if you put it off for say, four years, then it would be 48 percent higher," Mr. Leavitt said. "That means it would be substantially more expensive."

Those who already have prescription coverage, however, may want to consider sticking with it.

"If you're happy with it, just stay with it," Mr. Leavitt said. "Medicare is going to write a check to your plan to help them continue to offer this."

By offering plans 28 cents on the dollar for what they spend on prescriptions for those members, Medicare is hoping to encourage employers to keep offering it.

Medicare-eligible members of the State Health Benefit Plan in Georgia, however, face a big financial carrot and stick to enroll in one of the Medicaid prescription plans.

Those who do will get a $32.20 reduction in their monthly premiums for individuals, or $64.40 less per couple; those who don't, however, face a $64.40-a-month increase for individuals, or $128.80 more a month for couples. The state ran the numbers, and it was actually better off forgoing the subsidy and putting the incentives in to get those eligibles to enroll with Medicare as their primary pharmacy provider, said John Upchurch, the director of the State Health Benefit Plan.

"Our actuaries determined that there were more savings from that than if we had taken the subsidy," he said. "Most of (the Medicare-eligibles) will choose to sign up for Part D, I believe. Their benefit will be the same or perhaps a little bit better if they go ahead and do it. There's no downside to the members."

One concern raised at the town hall meeting was the cost of the program. Although it was originally thought to be about $400 billion over 10 years, the cost beginning next year through 2015 is now an estimated $912 billion, according to the Centers for Medicare and Medicaid Service's Office of the Actuary.

"Frankly, this is fairly expensive," Mr. Leavitt said. "Why are we doing it? We're doing it because we believe that by keeping people healthy, that in the long run the cost of our health care nationally will go down."

And while he admits that prescription drug costs are a concern, he thinks the new programs are already having an impact on that as well.

"The competition this has created in an organized market has at least for now caused the cost of drugs within the plan to go down," Mr. Leavitt said. "We're hopeful that trend will continue."

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.

Medicare Part D

Enrollment in Medicare Part D, the prescription drug coverage program, will begin Tuesday. For a guide to Medicare's prescription drug benefit, visit augustachronicle.com/rd/medicare. Call (800) MEDICARE (633-4227) or visit www.medicare.gov. Initial enrollment goes through May 15. Coverage begins Jan. 1.


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