ALERT! Medicare Part D - Time Is Running Out to Enroll
The Enrollment Period Ends on May 15, 2006

By Dr. Roland J. Larrabee

Judy Maier, a social worker at The Walter Aument Family Health Center, has alerted us to this important issue.

In January of 2006 a new benefit was added to the Medicare Program. This benefit known as Part D adds medications to the Medicare basic package. The goal of Part D is to enable Medicare participants to obtain their medicines at a reduced cost. The program is provided through insurance companies designated by Medicare.

It should be noted that everyone enrolled in Medicare regardless of income or age is eligible to participate in Part D.

While somewhat complex, the program provides for individuals with limited incomes to apply for a subsidy to assist them in purchasing their medicines. Under this provision of Part D if an individual qualifies, they are eligible to receive their medications without having to pay a premium or deductible. The basic cost for their prescriptions would be $1.00 for generic medicines, and either $3 or $5 for name brands. The individual must enroll with an insurance company who will provide the medications to them through a local pharmacy. Applications for the subsidy are available at the local Social Security Office.

Under the second provision of Part D, individuals with higher incomes must also enroll in the program by choosing an insurance company to provide their medications. These individuals will pay a monthly premium (varies according to the insurance company), and a co-pay for each medicine. Additionally people enrolled in this part of the program may have to pay a $250.00 per year deductible, again depending on the insurance company and plan they choose.

A major component of this portion of the plan is that once a patient reaches a total amount spent on medicines in a calendar year of $2,250, the insurance company ceases to assist the individual with the cost of the medicines until the individual has spent an additional $3,000 of their own resources for their medicines. Once this amount is reached the program then resumes and provides medicines for the individual at 95% of the cost per month. This gap in coverage is commonly known as the “doughnut hole.”

A key part of the new legislation is an open enrollment period for all individuals on Medicare to enroll in the program without penalty. This enrollment period ends on May 15, 2006. Once this date passes, the enrollment period ends (except for people newly eligible for Medicare) until November 2006.

Unfortunately for anyone who has not elected to enroll by the May 15th deadline and is in the non-subsidy portion of the program, there is a financial penalty for late enrollment. This penalty is a 1% per month increase in the premium. Thus anyone not enrolling by May 15th would pay a 12% increase in their premium when they enroll in November 2006. This penalty is permanent and increases 12% annually!
Help with enrolling in this program can be obtained by calling Medicare at 800-633-4227, by contacting Medicare on the internet at Medicare.gov, or by contacting the Appraise program at the Aging Office 717-299-7979.

Do it before May 15th if you intend to, or you will pay a greater price later.

Dr. Larrabee is Associate Director of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.