Boston.com Chat: Medicare

Diane Archer is special counsel and founder of the Medicare Rights Center. She is a nationally-recognized authority and respected consumer advocate who has spoken and published widely on Medicare issues. Ms. Archer is a past member of the Department of Health and Human Services Advisory Panel on Medicare Education and the Centers for Medicare and Medicaid Services National Medicare Education Partners (NMEP). Ethel Hi Diane, I heard that different states are offering different plans (California has 47 of them). I'm really confused. What plans are being offered in Massachusetts and why are there different versions state to state?

Diane_Archer You are correct. Different prescription drug plans are available in different states. To see what's available in Massachusetts, you should visit www.medicare.gov.

Roger Dear Diane: I saw on the news last night that there are different tiers for coverage. Can you explain?

Diane_Archer Yes. Whatever plan you choose, you will have out of pocket costs, including a monthly premium and copays each time you fill a prescription. Most likely, you will pay a higher copay for costly brand name drugs that the plan covers. What you pay exactly will depend on the plan. We will know a lot more about what different plans charge, whether they require prior authorization or impose quantity limits in January. You may want to wait to see how the different plans are working before you decide whether you want to sign up for one. New data from Canada suggests that you may pay less for your drugs if you buy them from Canada rather than get them through a drug plan.

Wilma Ms. Archer, my elderly mother has medigap and isn't sure if she should be going for this new program or not. How would you advise her?

Diane_Archer If she is in the traditional Medicare program, I would advise her to wait and see how these different plans are working before she signs up for one unless her income is low. If her income is below about $14,000, she may be eligible for extra help with premiums and copays and she should definitely sign up for that extra help through the social security administration.

clara Hi Diane. I've noticed a lot of TV commercials lately from drug stores saying to visit their store for answers on this topic. Are they are reliable source for this information?

Diane_Archer There is a lot of misleading information out there about the new drug benefit. What we know is that each drug plan will cover different drugs, cost you a different amount and work at different pharmacies. Moreover, the drugs covered and your out of pocket costs can change throughout the year. We are advising that you wait and see how the different plans available in your area are working before deciding whether to sign up for a plan. You have until May 15 to do so without penalty. And, if you do decide to sign up, you want to be as informed as possible about your choice since you are locked in to it for the year.

Lenny Hello Ms. Archer: I'm pretty disappointed that the first real improvement in medicare in decades is such a fiasco. I'm not sure where to turn to get information? Are there any good resources?

Diane_Archer This drug benefit does not work at all like Medicare, which is why people are so confused about it. You should be able to get objective information about your options from your state health insurance assistance program. If you don't have the number in your state, it's on the back of the Medicare and You book or you can call 1-800-Medicare for it. We also have a lot of helpful information at the Medicare Rights Center web site, www.medicarerights.org

MollyG Hello - my mother had real challenges understanding what to do - how do people start with this program?

Diane_Archer It all depends how your mother gets her drugs now. If she has a way to get her drugs at a reasonable price now and she can continue to get her drugs that way, she probably should wait and see how this program is working and what plans are giving people decent affordable coverage before she chooses a plan. If her income is under 150% of the federal poverty level though, then she may qualify for extra government assistance with the premium and copays and she should sign up for that assistance now. If she has Medicaid, she will automatically qualify for the extra help but will need to try to figure out which option is best for her before the end of the year. She should call her state health insurance assistance program for free advice. The number is available through 1-800-633-4227.

StephZ What happens if the company I sign up with goes out of business? Am I covered thru standard Medicare in that case?

Diane_Archer Good question. It is possible and indeed likely that some of the companies offering drug coverage now will stop offering coverage at some point, or will raise premiums and copays significantly. You will need to choose another drug plan if that happens. As of now, you cannot get the drug benefit through standard Medicare. The drug plan is only available through private insurance companies. Since each covers different drugs at different costs to you and works at different pharmacies, you should take your time to choose a plan that makes sense for you. You may want to wait to see how the different plans in your area are working before you choose one.

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StephZ Overall, what is the benefit of this plan supposed to be for me? How does it differ from Medicare itself?

Diane_Archer This benefit is compltely different from Medicare. Medicare gives you automatic, reliable coverage, a wide choice of doctors and hospitals and allows you to budget for your care by letting you have supplemental coverage to pay your coinsurance costs. You must sign up for these plans, they may change their coverage and costs at any time, they all have formularies that restrict the drugs they cover and they can also have prior authorization requirements and quantity limits. And, unlike Medicare, they require you to pay more each time you fill a prescription, punishing you financially if you need costly medications. Finally, since Congress refused to allow the government to negotiate prices with the pharmaceutical industry, prices for drugs will be high. That all said, while the drug plans offer only a meager benefit, you may be able to save some money on your medications if you sign up for one.

charlie It is more a comment, I think that the medicare organization is taking terrible advantage of our senior citizens and this country's citizens. It is a disgrace!

Diane_Archer It would have been very easy to incorporate drug coverage into Medicare Part B, which already covers some drugs as well as doctor services. Then, the benefit would have worked as well as Medicare, with negotiated prices and affordable medications and reliable coverage. Instead, the government is spending $720 billion, a lot of which is benefiting the drug companies and the HMOs and some people say that you could be better off getting your drugs from Canada than signing up for this benefit.

Diane_Archer I should add that this benefit was designed by our Congressional leaders in this way. It could have been designed very simply at far less cost. But Congress would rather have people enrolled in private plans so that it can control costs than deliver benefits directly through Medicare. What will likely happen in the near future is that Congress will cut payments to the drug plans which will force them to leave the market, raise premiums and copays and restrict even further the drugs they cover.

Bostondotcom Thanks everyone for chatting today.