New plan caters to individual needs

The drug benefit will help shift Medicare's focus from treatment to prevention.
YOUNGSTOWN -- The new Medicare prescription drug benefit plan will help individuals get plans that fit their personal needs, said Dr. Mark McClellan, administrator for the Centers for Medicare and Medicaid Services.
While most Medicare beneficiaries have some sort of drug coverage, it is from many different sources and is often incomplete. The new Medicare D, which takes effect Jan. 1, 2006, will provide drug coverage for everybody and their preferences of drugs and pharmacies. It is a voluntary benefit, McClellan said.
"People have from Nov. 15 to May 15, a six-month period, to sign up and they will have another opportunity later in 2006," he said. People not yet receiving Medicare will have six months to sign up after they turn 65.
However, like other insurance, Medicare's prescription drug plan will cost more if people put off signing up.
"That's why we want to get the information out now, so people can make an informed decision," he said.
Lower premiums
There will be a variety of plans to choose from that will all provide the coverage and meet the standards set by Medicare. The monthly premium will vary accordingly, McClellan said. The average premium will be about $32 a month, 15 percent lower than expected.
"It's about 15 percent lower because people in Ohio have choices, and the different drug plans are negotiating very hard to get lower prices," he said. "We need a partnership with people in Medicare; we need them to shop around and make sure they've found a good plan."
The basic Medicare drug benefit will have a $250 deductible, McClellan said. Medicare will pay 75 percent of the next $2,000. After someone has spent $3,600 on prescription drugs, Medicare will pay 95 percent of the person's prescription drug costs.
"There's extra help for people with very high costs," he said.
There is also extra help for people with limited means. McClellan said about one in three people in Youngstown are considered to have limited means, an annual income of about $19,400 for a couple, or about $15,000 for a single person.
An application is available from Medicare for people with limited means to apply for assistance. McClellan said those who qualify will have zero premium, no deductible and only a few dollars as a co-pay. The benefit would be worth about $4,000 a year.
"The application is four pages, so it's worth about $1,000 a page," he said.
Another important aspect of the new Medicare prescription drug plan is that it shifts Medicare's focus from treating disease to preventing disease, McClellan said. Rather than paying for an expensive surgery, Medicare should help people get the less expensive treatments they need so that surgery isn't necessary.
"Today, Medicare pays the bills when things go wrong -- in Medicare, we need to shift the focus to prevention," he said.
McClellan said a one-size-fits-all blanket plan doesn't allow Medicare to keep up with modern medicine and an individual's needs.
The drug plan will be paid for by Medicare and the beneficiary, McClellan explained. For every $1 the beneficiary contributes, the federal government contributes about $3; that's a 75-percent subsidy from the general government revenue, he said.
McClellan added that Medicare is working with Ohio Senior Health Insurance Program and its local office, and with the Youngstown area Agency on Aging to ensure Ohio Medicare beneficiaries have access to face-to-face help. Information can also be obtained by calling (800) MEDICARE.

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