Medicare-enrolled retired federal workers who have enjoyed free prescriptions by mail for years will have to pay part of their prescription costs starting in January.

Although new copayment amounts will be small compared with the high cost of many drugs, they will come as an unpleasant surprise, especially to low-income retirees who require numerous maintenance drugs to stay healthy--or alive.

Next year, all nationwide fee-for-service plans in the federal program will impose a copayment for mail-order drugs for retirees enrolled in Medicare. In effect, it means that those people will pay the same deductibles and copayments that are required of workers and retirees who aren't under Medicare.

Most active-duty federal workers, and the vast majority of federal retirees, are in fee-for-service plans. They let individuals and families pick their own doctors and hospitals. Fee-for-service plans include Blue Cross-Blue Shield (the largest), as well as GEHA (Government Employees Hospital Association), plus union-backed plans such as Alliance, Postmasters, Mail Handlers, Letter Carriers and American Postal Workers Union.

Prescription drug practices of local health maintenance organizations in the federal health program will vary. Brochures will soon be available.

Most health plans require copayments for prescription drugs picked up at a pharmacy. Those who pick up drugs are usually limited to a 30-day supply.

Drug-by-mail plans differ. Some require covered individuals to satisfy a deductible before the reduced price benefit kicks in. Others will charge one fee (typically $5 per prescription this year) for generic brands, $15 to $25 for brand names.

Many of the most popular drugs prescribed for long-term (as in lifetime) treatment of high blood pressure, thyroid treatment, or to lower cholesterol, for example, cost hundreds of dollars for a 30-day supply without a prescription benefit.

Currently, Medicare-enrolled retirees who are also on one of the fee-for-service plans can get prescription drugs free (no matter how expensive they are) if they order them by mail. They get a 90-day supply. That--for drugs that cost $300 or $400 for a 90-day supply--is a good deal.

And too good to last.

Once health plan brochures begin to arrive, federal workers and retirees who read carefully will learn of changes in the prescription drug benefit for people covered under Medicare.

Blue Cross-Blue Shield, the largest plan in the federal health program, will charge a $10 copayment for a 90-day supply of drugs by mail, if they are generic drugs. For those who insist on or must have a brand name, the charge will be $20 for a 90-day supply.

Copayments in other plans will vary but will be in the same ballpark.

The problem is that drugs, even generic drugs by mail, are expensive. Some health plans found they were spending nearly as much (or more) on prescription drugs as they were on all other medical procedures combined. So they have been given permission to charge what, for many costly drugs, will be a token payment.

Federal workers and retirees in the Washington-Baltimore area are fortunate in that they are eligible for at least 14 health plans. And nobody can be rejected because of age, current health or preexisting medical condition. The open season when people can switch health plans begins Nov. 8 and runs through Dec. 13.

US Aetna Health Care

Some folks enrolled in the Aetna HMO have taken issue with the new 2000 premiums for their health plan printed this week in this column. Although Aetna's premiums are going up next year, the amounts shown here are less than those folks are currently paying. How, they ask, can that be? Mystery solved. Bill Smith of the National Association of Retired Federal Employees points out that those people were once part of the NYLCare health plan, which will be taken over by Aetna in January. Folks who are in NYLCare this year will continue to pay its higher premiums for the rest of 1999. Those who don't change plans during the open season will be enrolled in the Aetna plan.

Financial Planning Seminar

At 9 a.m. tomorrow (Saturday) on WUST radio (1120 AM), financial planner Jack White will discuss what people should be doing--regardless of age or where they work--to make sure inflation doesn't ruin their retirement.

At 10 a.m., federal benefits specialist Tammy Flanagan and tax specialist Bob Leins will discuss how to maximize benefits, minimize your tax bill and why Dec. 31--not Jan. 1--is the best date to retire.

Mike Causey's e-mail address is causeym@washpost.com