washingtonpost.com
Medicare
Prescription Drug Coverage

Mark B. McClellan, M.D., Ph.D.
Administrator, Centers for Medicare & Medicaid Services (CMS)
Monday, November 14, 2005 1:00 PM

Medicare Chief Mark B. McClellan, M.D., Ph.D., was online Monday, Nov. 14, at 1 p.m. ET to discuss steps for enrollment as Medicare prescription drug coverage begins on Tuesday, Nov. 15.

From The Post:

Full Coverage: Medicare and You

Interactive Map: State by State Data

The Transcript follows.

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Mark B. McClellan: Thank you for the opportunity to chat with you today. This is an important time in Medicare, as we are adding the most important new benefit to the Medicare program in its 40-year history. The new drug coverage is available to everyone with Medicare. People with Medicare can sign up starting tomorrow, November 15, but there's plenty of time to make a decision. If you enroll by the end of December you can get coverage on day one, January 1 2006. You have until May 15, 2006 to make a choice. And there are lots of places to go for help, including medicare.gov. It's worth finding out about - coverage options start for a lot less than people expected, under $20 a month almost everywhere in the country, and Medicare will typically cover more than half the costs of drugs compared to not having coverage.

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Ft. Myers, Fla.: Where do I get list of plans in this area?

Mark B. McClellan: You can go to www.medicare.gov and click on the "Landscape of Local Plans." This list gives you information on plan features like deductible, premium, availability of mail-order, and availability of extra coverage.

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Galloway, N.J.: Once I have decided which option I want to take, how do I actually sign up? Is there a written application to be filled? .

Mark B. McClellan: You can enroll in several ways: by written application from the plan you've chosen, online at www.medicare.gov or on the plan's Web site, or by calling 1-800-MEDICARE. The enrollment action has to be initiated by you - a plan cannot ask you for personal or financial information as part of its marketing activities.

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Anonymous: If I enroll with one company, can I switch companies later or do I have to stay with the original company forever?

Mark B. McClellan: Generally, you can change plans once a year, just like all Federal employees and most other Americans. During this first enrollment phase that starts tomorrow, you can switch plans once between January 1st and May 15th. After then, you will get another chance to change during the November-December 2006 enrollment period. If you are a "full benefit dual eligible" with both Medicaid and Medicare, you can change plans at any time.

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Portland, Ore.: I am a senior with very low income. How is the "donut hole" going to affect me? They say I will have no premium and low co-pays, but what happens when I hit the gap in coverage? Am I stuck paying whole cost of my medications during that period between $2250 and $5100 every year? I cannot afford to do that.

Mark B. McClellan: Another good question. In addition to the basic Medicare benefit, Medicare is providing extra help to people with limited means - about 1 out of 3 people with Medicare. If you qualify for the extra help, you will not have any coverage gap at all. On average, for people with extra help, Medicare will pay for about 95 percent of your prescriptions for no premium, no gap in coverage and only small copayments. If you still have questions about your coverage, we'd welcome your call at 1-800-MEDICARE.

If you have higher income and don't want a coverage gap or "donut hole," then you can choose a plan option that provides coverage through the gap. So if you don't want a donut hole you don't have to have one.

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Portland, Maine: I am 65 and on Medicare. I do not take any prescription drugs. If I do not sign up for prescription drug coverage and eventually need to take prescription drugs, will the new program help to pay at that time, or am I expected to sign up now for what might happen eventually?

Mark B. McClellan: It's great that you are healthy enough to not have to take any prescriptions now. Yes, if you wait to sign up until later, you can still get Medicare drug coverage and Medicare will still help pay for your drug costs. However, you will generally have to pay more if you wait until after May 15, 2006 to enroll. The Part D drug coverage works like Medicare Part B (physician insurance) and like other kinds of insurance - if you wait to sign up until you need it, it will cost more.

You might want to consider signing up for drug coverage now to protect you in case you do need coverage sooner than you can expect. In Maine, as in other states, you can get a stand-alone prescription drug plan for less than $20 a month, or a Medicare Advantage plan that will cover prescription drugs and other medical expenses. You can call us at 1-800-MEDICARE or go to www.medicare.gov for more detailed information.

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Bethesda, Md.: If you are a nursing home resident, how does the new plan affect you?

Mark B. McClellan: Everyone with Medicare, including people who reside in nursing homes, is eligible for the Medicare drug coverage. In fact, most people in nursing homes have Medicaid coverage and Medicare, and they will have access to Medicare drug coverage for zero premiums and zero copays for the drugs they need. Even if you aren't eligible for Medicaid as well as Medicare, all the Medicare drug plans must provide access to the drugs you need in a nursing home as well as in the community.

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Anonymous: How does AARP Plan J (with prescription coverage) compare with Medicare Part D Rx coverage, cost vs, comprehensive coverage for average seniors? Will AARP Plan J continue to be offered or will Part D replace it? All literature in mail is extremely confusing, vague and difficult to make intelligent comparisons, choices.

Mark B. McClellan: People who have drug coverage through Medigap, like Medigap Plan J, can continue it in 2006. However, this coverage is not as good as the basic Medicare drug benefit - meaning it doesn't provide as comprehensive coverage or as much help with drug costs, whatever your drug needs. So if you don't enroll in a Medicare plan by May 15, 2006, you will probably pay more for Medicare coverage if you decide you want to enroll later.

You should really take a look at the new coverage. Unlike Medigap, which you have to pay entirely on your own, Medicare will provide help that amounts to half or more of drug costs for a typical senior. And there are coverage options available that provide very comprehensive coverage for much less than Medigap drug plans generally cost today.

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Norwood, N.C.: I am a retired airline employee with no insurance as part of my retirement. I am on medicare an have a supplemental policy with no medicine coverage. I must purchase all my medications out of pocket. My wife is a retired state employee on medicare with her state insurance as supplemental. She pays a co-pay. If she opts for the medicare medical payment she loses her state supplemental and cannot re-enter that program. Would it benefit both of us, or just me to enter the medicare medicine program?

Mark B. McClellan: Good drug coverage offered through retiree drug plans can now qualify for new subsidies from Medicare to help keep that coverage secure. Millions of people with Medicare will be getting assistance through their retiree plans next year. So your wife should review the information she's getting from her retiree plan (sounds like she already has started doing this) and if she likes it, she should continue it. You can still enroll in a Medicare plan yourself - and if you aren't getting any help with your drug costs now, Medicare coverage can help you save money and protect against high costs in the future. For more information on what the coverage means for you, you can go to medicare.gov or 1-800-MEDICARE.

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St paul, Minn.: My 40-year-old son is on disability medicare. One of his prescriptions costs $500 a month. For all these years, medicaid has paid. This November without prior notice, he was told that medicaid, that his co-pay was $300! We are unable to get any answers from the state. What's up?

Mark B. McClellan: Starting January 1, your son will get comprehensive drug coverage through Medicare. The "extra help" available for people who are on Medicare and Medicaid means that any covered prescription will have a copay of at most a few dollars per month. People with Medicaid and Medicare are being notified now about their eligibility for this comprehensive coverage, and about the drug plan that will be providing this coverage if they don't choose a plan on their own. You can find out more now about how his new Medicare drug coverage will work by going to medicare.gov or calling 1-800-MEDICARE.

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Santa Fe, N.M.: My secondary insurance is TRICARE4LIFE, It is my understanding that I can receive my medications at an affordable price for a senior of 77 years through the National Mail Order Pharmacy. Do you have any comment on this?

Mark B. McClellan: People who have TRICARE 4 LIFE and people who are retired Federal government employees with benefits already get very good drug coverage as part of their retirement benefits. These benefits are not changing with the new Medicare coverage. So if you have TRICARE or Federal Employees coverage and you like it, you can just keep it - you don't need to do anything else.

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Capitola, Calif.: I now have Plan J and my Medigap coverage is with Blue Cross. I have no Rx costs to speak of now. Blue Cross covers a portion. Should I change out of the Plan J? I want a PPO.

Mark B. McClellan: In California and virtually every other state in the country, people can choose to get their Medicare drug coverage through a Medicare Advantage plan. These are private plans in Medicare that provide the whole set of Medicare benefits - not just drug coverage but also hospital, physician, and other services - as part of an HMO, a PPO, or a private fee for service plan. In particular, California will have PPO options available next year. These private plans generally rely on a network of "preferred" doctors and hospitals to provide more coordinated care. Many people like to get their care that way, and on average you can save about $100 a month in Medicare Advantage compared to enrolling in traditional Medicare, because the Medicare Advantage plans generally offer more comprehensive benefits and you don't need Medigap insurance. But the choice is up to you - if you prefer to stay in the traditional Medicare plan and get a drug benefit added to it, you can do that too. If you choose traditional Medicare and a Medicare drug benefit to go with it, you can switch from Plan J to a much less expensive Medigap plan with no drug coverage. It's up to you - and to get more help in comparing your options, you can go to medicare.gov or 1-800-MEDICARE.

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Petersburg, Va.: I have been reading everything I could get my hands on about Medicare's new prescription drug coverage - newspapers like the New York Times and The Washington Post, plus all of the information that the government has issued. I have to tell you that I don't trust my government to consider my best interest. Perhaps that might be different if I were wealthy. That's a sad sign of the time. Instead, I am a 70 year old unmarried retiree who received no severance pay after 32 years in one healthcare job. I am, however, fortunate to have paid into a retirement fund and I have social security Together I realize a monthly income of $ 2500. I have the best Medigap coverage I could find (Plan J -- which covers some medications). That coverage costs me $ 275 each month. Why should I let that go, even though it costs me dearly? It's so confusing.

Mark B. McClellan: Rising health care costs are a real problem for retirees, and that's been especially true for prescription drug costs. With the new Medicare coverage, the government is not trying to force you into a "one size fits all" plan that may not be what you want. Instead, you have a choice about your coverage, and we can help you get the information you need to choose a plan that is a good fit for you. Because of the choice and the strong competition among prescription drug plans, the cost of the Medicare coverage is turning out to be significantly less than many independent experts predicted. There are plans available for under $20 a month that will cover about half of drug costs for a typical retiree, and there are plans that offer very comprehensive coverage with no gap - better than the coverage you can get through Medigap - for only around $60 a month. So it's worth taking a look - and you can get personalized information about what the coverage means for you by going to medicare.gov or calling 1-800-MEDICARE.

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New Britain, Conn.: How will Medicare D impact chemotherapy drugs? Will they be limited in scope? Will most recent drug discoveries be available? Who decides therapy: doctor or insurance plan???

Mark B. McClellan: All of the Medicare prescription drug plans are required to cover all medically necessary drugs. In the case of cancer drugs, because the specific chemo drug or other drug may really matter, all of the plans are required to have essentially all of the drugs on their formularies (the covered drug lists). Beyond these broad coverage requirements, if there is nonetheless a problem about coverage for a drug that your doctor thinks you need, plans are required to have expedited processes for you or your doctor to be able to get coverage for the drug, as well as appeals for coverage that are reviewed independently by Medicare, not by the drug plan. Because the drug plans have broad coverage for cancer drugs, we expect that the plans will be a great help in providing access to the most effective new cancer treatments.

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Arroyo, Puerto Rico: I receive my prescription drugs thru the Department of Veterans Affairs. Do I need to, forcibly, enroll in any Advantage Coverage? Please elaborate.

Mark B. McClellan: If you are happy with the coverage you are getting through the VA plan, you can just keep that. You do not need to sign up for a Medicare drug plan. However, Medicare coverage works through many more local pharmacies and includes formularies (drug lists) that have many medications not on the single VA formulary. So some people who are eligible for VA coverage may want to consider the Medicare coverage too.

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VanNuys, Calif.: Why do info and prices change so frequently on plan finder tool? Some of my drugs and copays went up today as compared to last week!

Mark B. McClellan: The prescription drug plan finder, for the participants who haven't heard of it before, is an unprecedented tool that is available to help people find out more about the cost of their drugs at their local pharmacy. It's available at www.medicare.gov - all you need to do is enter your drug names and preferred pharmacies (if any) and you can get a detailed estimate of what your drugs cost under the plan options available.

This tool just went "live" for the first time last week, and many plans are updating the information they have available. Also, drug prices can change - it's just that until now, people didn't have any easy way to find the best prices for their drugs. In fact, some have lowered prices as they see for the first time how well they are doing against the competing plans. And many plans are offering coverage that can reduce drug costs substantially, by 50 percent or more compared to not having coverage.

But this is a very new tool and there is plenty of time to make a decision about coverage. While it is very clear that there are a number of options available that can help you save money on the drugs you take, you can also wait a little while if you want to make sure you are choosing a plan that is a very good fit.

Medicare will continue to oversee the information provided by the drug plans, to make sure that no plan is providing misleading information and to make sure that people can get much more accurate information on discounted drug prices than has ever been possible before.

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Idaho Falls, Idaho: I am 66, still working and having med drug coverage through my employer. If I retire, let say in 2007, could I sign up at that time for Medicare drug coverage? Secondly, will I pay "penalty" (1 percent/mo?)for missing May 15, 2006 deadline? Thanks.

Mark B. McClellan: If you are currently working and have "primary" health insurance through your current employer, you can continue that coverage and enroll in the Medicare coverage when you retire, without paying a penalty. The only people who have to pay more if they wait to sign up are people who are not enrolled in coverage that is at least as good as the Medicare drug benefit by May 15, 2006. Federal employees coverage, Tricare coverage, VA coverage, most employer and union retiree plans - these are all examples of coverage that is at least as good as the Medicare basic drug benefit, and if you have this coverage you won't pay a penalty to enroll later. People who are retired should look for information from their former employee or union.

The reason the additional payment is required for people who don't have good coverage is the same reason it is there for Medicare Part B and for many other kinds of insurance, like homeowners' insurance - if you wait until you really need it to sign up, you will pay more.

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Mark B. McClellan: Thank you all very much for the very good questions. I didn't get a chance to answer all of them though we covered a lot of topics today. If you want to find out more, as I've mentioned before you can go to www.medicare.gov to get personalized help. If you're on Medicare or if you have a family member or loved one who is, we provide personalized help online. People can also get help by calling 1-800-MEDICARE anytime.

This is the most important new benefit in Medicare in 40 years, as Medicare starts to move from mainly paying the bills when people get sick to putting just as much emphasis on preventing diseases and the complications of chronic diseases. Prescription drugs are absolutely essential for this. And because people can choose how to get their drug coverage, we are seeing options that are better fits for our very diverse beneficiaries - with lower costs and better coverage than many people expected. So if you or someone you care about has Medicare - and that means most people - it's worth finding out about this new coverage.

Enrollment begins November 15, sign up by the end of December for coverage starting on January 1, and the first enrollment period runs all the way to May 15, 2006, so no need to rush - and lots of places to go for help. Thank you all for working with us as we bring Medicare up to date and help all of our beneficiaries live longer and healthier lives.

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