As the New Year kicked in, a bit of confusion was played out in Secaucus as seniors, social service workers and local drug stores tried to get used to the new Medicare Prescription Drug Plan – Part D.
Due to the complexity of the program, the newness of the concept and a large volume of recipients scrambling for eligibility, there have been a few snags along the way to implementing the plan, which began Jan. 1. Medicare began providing prescription drug coverage for the first time in its 40-year history.”Some of the pharmacists were saying that Part D stands for disaster,” said Joseph Marra, one of the Pharmacists at Marra’s Drug Store on Paterson Plank Road. “The biggest problem was that many people didn’t get their cards right away.” Enrollment began on Nov. 15, but ID cards were not available right away. While many residents who are eligible received letters from Medicare that they could take to their drug stores to use, they either didn’t understand the letter or threw it away. Because an ID number was necessary to fill the prescriptions, the store was inundated with requests for the pharmacists to call Medicare. “Once we got the numbers, everything went well. But because of the volume of people who needed their numbers, after a point we couldn’t call for them,” said Joseph’s cousin Darin Marra, also a pharmacist. “It’s gotten better now, but the first week or so, everyone was overwhelmed.”
The goal of the new plan is to provide prescription drug coverage nationwide for those eligible for Medicare. It also serves those who are “dual eligibles” – those who are also eligible for Medicaid (for the poor). Dual eligibles were automatically enrolled. All other Medicare recipients needed to enroll themselves.
“Some of the private insurance companies have been so aggressive in soliciting recipients that some of people have enrolled twice,” said Darin Marra. “We learned a lot from the people who come in [to Marra’s store]. The plan is still causing some problems and misunderstandings.”
The confusion stems from the scope of the prescription drug plan and the amount of different situations it will cover.
What it’s all about
Medicare is for people 65 years of age and older. It can also include disabled people under 65 years of age. Medicaid provides health insurance coverage to the nation’s poor and disabled.
“Some of things people have to think about with the new plan is how much they want to spend, what program to sign up for, and whether or not the $250 deductible is worth it,” said Director of the Secaucus Department of Social Services Karyn Urtnowski. “It’s great for very low income seniors. For people with prescription drug expenses less than $100 a month, Part D is not worth it.”
Urtnowski said the premium is about $28 to $66 a month, and co-payments are 25 percent of the cost of the drug. During each year, the plan will cover $2,250 for prescription drugs. After that, the person must spend $3,600 out of pocket before the plan will pay for any more prescriptions. When the cost of the recipient’s prescription drugs reaches $5,100 (including the $3,600), they will pay only 5 percent of the cost.
Anyone on Part D must also decide which insurance company to use. In the new plan, even though the plans are approved by Medicare, they are administered by private insurance companies. Thus there are many options with different deductibles, premiums, and coverage.
“Consumers should choose an insurance plan that will pay for their most expensive prescription,” said Urtnowski. “I’ve been helping people use the Medicare website, where you can list your prescriptions and find out which plan is the best for you.”
Urtnowski said other considerations would be which pharmacy will accept the plan you pick.
“Some people may not want to go to Wal-Mart and pay a little extra to get a plan that is accepted by Marra’s or CVS.”
Help at senior housing complexes
Anyone living at the senior housing towers should visit Secaucus Housing Authority Social Services Director Nina Villaneuva at Kroll Heights if they need help selecting an insurance company for Part D.
“It’s been a ride working with this new plan. Some had difficulty with it; others did not,” she said. “There’s a lot of information and many changes. There had to be some confusion, but we’re getting there.”
Resident Robert Santomenna said he was very satisfied with Villanueva and the new plan. He said he takes eight different medications and only gets $700 a month on Social Security.
“I’m 77 years old, so it was a little bit hard to get through it, but it went smoothly,” Santomenna said. “The new program helps a lot. It’s good for me.”