Even as state officials push to sign up seniors for Medicare prescription drug programs before the May 15 deadline, some enrollees are finding unexpected costs in the program that could push them toward a gap in their coverage.
The GeorgiaCares program is hoping to get hundreds of thousands of Georgians who are eligible for Medicare Part D prescription drug plans to choose one soon.
"We've got about 200,000 Georgians that need to sign up yet," said Jennie Deese, the director of GeorgiaCares. "They may be people that are homebound, people that may not watch TV. It may be people that are visually impaired. Or it may be people that are just waiting because they don't take any medication."
That could be a problem because they will incur a permanent 1 percent per month penalty for every month after May 15, and the next enrollment period will not start until Nov. 15. They should think of it as buying insurance for which they will have a fair premium for prescription coverage should they suddenly need more drugs, Mrs. Deese said.
"When you purchase car insurance, you don't purchase car insurance with the hope that you'll have a wreck in a week. You purchase it for that protection, and this is the same thing," she said.
Dan Silliman, 77, of Augusta, did what he was supposed to do and signed up early so his coverage would start Jan. 1, when the program began. Now he finds that with six daily medications he is quickly getting to a $2,250 limit, beyond which his AARP MedicareRx Plan will no longer cover the costs. Coverage will not resume until his costs reach $5,100.
Mr. Silliman thought only his 25 percent co-pay would count toward the cap, but in reality it is also what the plan is paying. His coverage cost was more than $1,500 by the end of March.
"This kills us," Mr. Silliman said. It also was news to one former Medicare official who was in on the design of the program.
"It should be the out-of-pocket cost by the individual, not the retail price of the drug," said Rob Foreman, former director of legislation for the Centers for Medicare and Medicaid Services. "That doesn't sound right. That's not correct."
It doesn't seem fair to Mr. Silliman.
"That's the way it's designed, but that's not the way it's working," he said.
In fact, that's how all of the plans are operating, said Dominick Washington, spokesman for UnitedHealth Group, which is overseeing the AARP plan.
"The shared expense between the plan and the member, up until the $2,250, is what counts towards that number," he said. "It's not the full retail cost; the prices are negotiated down substantially from that by the plans."
Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.
MEDICARE PART D
The GeorgiaCare program will be providing help over the phone tonight for those who have questions about the Medicare Part D prescription drug program. In conjunction with Georgia Public Broadcasting's Georgia Weekly program beginning at 7 p.m., Medicare eligibles can call to get information toll-free until 9 p.m.
Georgia has enrolled 443,000 Medicare recipients in prescription-only plans, and 39,300 others get coverage through Medicare Advantage plans.
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