News Summary

Q&A on the Medicare drug program

WASHINGTON — Questions and answers about the Medicare Part D prescription drug program:

Q: I haven't signed up for Medicare Part D yet because I have asked AARP and my local pharmacist, and both said that I didn't need to. I still am unsure. I buy my medications from Israel (prior to that, Canada). I'm taking Advair, Zocor, Nexium and Actonel. They cost about $514 a month. I am told I fall into the "doughnut hole" so I don't have to buy Part D.

- Ann in West Palm Beach, Fla.

A: If you are taking several expensive drugs, you probably would see some savings in a Part D plan. You can enroll in a stand-alone drug plan that does not have a "doughnut hole" - which refers to a period after the total cost of your drugs reaches $2,250 when you pay full price - and purchase the drugs you are taking for less than $514.

Even if it is cheaper to purchase drugs from Israel, there is always the possibility the federal government will crack down on that source the way it is now doing on some drugs coming in from Canada.

To find an inexpensive plan, use the Medicare drug plan comparison tool on the Internet (www.medicare.gov) or call the Medicare hot line at 800-633-4227 for personal help. Where you live, there also are other organizations such as the Area Agency on Aging's Medicare Answers Prescription Savings at 561-688-1211 that provide free counseling.

Q: If you are 65 and have AARP's Medigap insurance coverage, do you need to sign up for the Medicare drug program? Will they assign you to a plan if you don't do anything?

- Gail in Atlanta, Ga.

A: Your Medigap plan should have notified you last fall whether its drug coverage is considered "creditable," meaning it's as good as or better than Medicare Part D. Most Medigap drug plans are not as good. That means if you keep your Medigap drug plan and drop it after May 15 you will have to pay the 1 percent-a-month penalty to enroll in a Part D plan.

You can purchase a stand-alone Part D plan and drop the drug portion of your Medigap plan, which will lower the premium for your remaining Medigap coverage. You cannot have both a Medigap drug plan and a Medicare Part D drug plan. They will not automatically assign you to a plan.

Q: My husband is retired and is covered under my insurance. Some time ago my employer sent a letter informing me the prescription plan I had was better than the Medicare plan, so I did not change. Should I have kept this letter? If I retire in a year or so, can I then get us into the Medicare prescription plan?

- Emily in Palm Beach Gardens, Fla.

A: You should contact your employer and get another copy of that "creditable coverage" letter and put it in a safe place. You may need it to prove you had creditable coverage, so you don't have to pay the enrollment penalty. When you retire, you and your husband should be eligible to enroll in a Medicare Part D plan without penalty.

Q: Does my employer's health insurance company have the authority to make me enroll in the Medicare Part D program? They are saying that if I don't enroll in Part D, I will no longer have any insurance coverage. My understanding was that it was my decision to make if I want to enroll in Part D and nobody or no insurance company can force me to sign up. Is this true?

- Ed in Delaware, Ohio

A: You're right, they cannot force you to enroll in Medicare Part D. However, they can drop your insurance coverage any time they want. If that happens, and you haven't enrolled in a Part D plan, you'd be left without any coverage. So it's your choice: Enroll in Part D, go without coverage, or try to find a private insurance plan that is not subsidized by Medicare (which would probably be more expensive).

Q: When you reach the "doughnut hole" do you still have to pay the monthly premium? Does the prescription cost remain the same, or does it go up to the high cost you paid before joining Part D?

-?Martin in Boynton Beach, Fla.

A: Inside the "doughnut hole," you have to pay the full price of your drugs. In addition, you still have to pay the monthly premium. However, once your total drug costs exceed $3,600, then Part D will pay 95 percent of your drug costs for the remainder of the year.

Confused about the new Medicare Part D prescription drug program? Cox Newspapers Washington Bureau reporter Larry Lipman answers selected questions from readers. Send your question, with your name and city, to medicaremailbagcoxnews.com.