12/29/05 — Officials say there are not enough counselors to explain drug plan

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Officials say there are not enough counselors to explain drug plan

By Andrew Bell
Published in News on December 29, 2005 1:49 PM

With 19,095 Wayne County residents eligible for the federal government's new Medicare prescription drug program, seven certified counselors to assist senior citizens is not enough, county officials said.

"We have gotten 75 calls in one day. That's tough for three people that have full-time jobs on top of this," said Yvonne McLamb, the director of the county's Services on Aging program. "During our public enrollment day at the library, we enrolled 85 people."

Other counties are having the same problem, officials say. But social service agencies are trying to make older residents aware of the new program that takes effect soon. Wayne officials have held educational forums across the county for the past several months, Mrs. McLamb said. They also have turned to churches and radio stations to help spread the word.

Enrollment for the drug plan, known as Medicare Part D, began Nov. 15 and will end May 15.

If a person enrolls for the program by Dec. 31, the coverage will begin on Jan. 1. If they wait until Jan. 1, there will be a 30-day delay in obtaining coverage.

Enrollment after May 15 could result in a 1 percent per month premium penalty.

Mrs. McLamb recommended Wayne residents interested in signing up for the drug program visit the Services on Aging office at 100 S. James St. to fill out a Medicare drug coverage form.

Those interested will need their Medicare claim number, a list of current medications with the correct dosage and the approximate out-of-pocket cost for 30 days worth of prescriptions, Mrs. McLamb said. With this information, a counselor can find rate comparisons and mail the results to the individual.

McLamb emphasized that all people receiving Medicare are eligible to enroll in a prescription drug plan regardless of income or assets. However, there are special groups that have the choice of accepting the Medicare package or not.

If a person is covered under a Medigap H, I, or J plan, they currently have prescription drug coverage. These individuals could maintain this coverage or have the prescription drug benefit removed from their policy and enroll in a prescription drug plan, McLamb said.

Also, many employers have chosen to participate with the new package by continuing to offer the prescription drug coverage offered to their retirees, according to the department.

Since this coverage is equal or better than Medicare's coverage, McLamb said the coverage would be subject to the 1 percent penalty if it is canceled in the future. Examples of this coverage include TRICARE for Life, the Veterans Affairs, the Federal Employees' Health Plans and the North Carolina State Health Plan.

Anyone interested in volunteering to help assist Services on Aging in enrolling eligible residents into a prescription drug plan is welcome, Mrs. McLamb said. For more information, call her at 731-1591.

Each plan available through Medicare differs in medications, drug prior approval requirements and payment structures. These differences have an impact on the size of the premium, which can range from $20 to $68 in North Carolina, Department of Insurance officials said.

There are 16 approved companies in the state that offer a total of 38 prescription drug plans, McLamb said. Of those, 10 offer national coverage for beneficiaries that have residences in more than one state, according to the department.

Although the plans may not be identical, each one must be at least equal to Medicare's standard coverage model. According to the coverage outline, the beneficiary would be required to pay the full amount on drugs that cost up to $250. The beneficiary cost for drugs priced between $250.01 and $2,250 is 25 percent of the actual drug cost.

Prescription drugs priced between $2,250.01 and $5,100 are not covered by Medicare, leaving the beneficiary to pay the full amount. However, if a prescription drug costs more than $5,100, the beneficiary only pays 5 percent of the total, according to the outline.

For more information on the Medicare Part D package or the prescription drug plans, visit www.medicare.gov or www.ncshiip.com. Individuals could also call 1-800-MEDICARE.