Drug discount options confusing

Drug discount options confusing
THE Medicare legislation of 2003 created a voluntary prescription drug discount card that will be in effect from next month through Dec. 31, 2005. The card will expire in January 2006, when the new Medicare Part D drug benefit takes effect.


Medicare recipients, except those with full drug coverage under Medi-Cal, can purchase a Medicare-approved discount drug card during May, which happens to be Older Americans Month. While the new card should help seniors carry out the month's theme, "Aging Well, Living Well," most seniors who know about the card are having a hard time getting beyond the confusion it has created.


People with low incomes (below about $12,500 for individuals and $16,800 for couples) can acquire a card with $600 preloaded (like a phone or debit card) into it for 2004 and another $600 for 2005, plus a discount on purchases above those annual subsidies. Except for a small co-payment, the cost of medications will be deducted from the $600. However, Medicare beneficiaries who are covered by Medi-Cal with full drug coverage, or have drug benefits through employment, retiree coverage, the Veteran's Administration or TRICARE, are not eligible for the low-income benefit.


Those who are enrolled in Medicare HMOs will be limited to the card offered by their insurer. For most other higher-income Medicare recipients, the new card option seems either too confusing or hard to compare with other options available to them.

First, there are dozens of approved cards to choose from. Second, California already offers a free drug discount benefit of 10 percent to 25 percent to Medicare beneficiaries. Third, many seniors are enjoying discounts from online pharmacies or retailers such as Costco that in some cases are deeper than the 10 to 15 percent expected from the new cards.


Another factor that makes the choice difficult is that once recipients choose a Medicare drug card, they cannot switch to another card until the end of the year. However, companies issuing the cards can change their prices or which drugs are available at any time. Many seniors are asking themselves, "Why should I risk seeing my ongoing medications become unavailable or more expensive than the deals I can count on from other options?"


What can consumers do? First, you can wait and see how things develop. Second, research options on your own with help from such resources as Medicare's Web site ( www.medicare.gov or toll-free number: (800) MEDICARE (1-800-633-4227). However, beware that the accuracy of drug price comparisons on that Web site is being questioned and the toll-free number requires getting through several layers before reaching a live person.


Third, you can take advantage of local programs that explain options and help with research and decision-making. One such program is the Health Insurance Counseling and Advocacy Program (HICAP) ( www.calmedicare.org or 1-800-434-0222). You can meet with a trained HICAP volunteer to review your prescription drug needs and a variety of discount options that are available to you, including the new Medicare discount cards. If you do not have access to the Internet for research and cost comparisons, HICAP may provide that kind of assistance. They also are available to make presentations to community groups.

One final note: Please do not call us with specific questions about the Medicare drug card. Because we are not experts in that subject, we encourage you to contact HICAP for assistance.

Sandra J. Cohen, R.N., and Roger Cormier are consultants who help East Bay families plan and coordinate care of an older relative at home or in a care facility. You can reach them at (510) 652-3377 or (925) 945-8855 or visit www.ElderCareManagers.com