RespiteMatch.com Health Blog

Seniors — and their children — can start poring over the vast array of choices being offered by health plans for Medicare next year.

BY JOHN DORSCHNER
jdorschner@herald.com

Starting today, 43 new Medicare drug plans and about two dozen health maintenance organizations will begin bombarding South Florida seniors with details about their offerings.

Seniors — and their children who may assist them — have six weeks to ponder a vast and probably confusing spread of offerings before the sign-up period begins Nov. 15.

The benefit starts Jan. 1, the final result of a Medicare overhaul passed by Congress in 2003 to give seniors what they had long been demanding — a drug benefit to go with the government’s health plan for those older than 65.

To decide on what’s best for them, seniors this fall will be contemplating a dizzying array of monthly premiums, co-payments, deductibles and other alternatives with one general theme: The more a person pays, the more benefits he or she receives.

The best deal, however, may be to forget the drug plans and go with a Medicare HMO with expanded drug coverage, said Medicare chief Mark McClellan in a conference call Friday.

More information on the drug plans and the HMOs is scheduled to become available on Oct. 13, when the website Medicare.gov offers seniors the ability to compare plans by entering the drugs they ordinarily take and see which plan offers the most for them. As passed by Congress, the standard drug plan being offered for the first time in 2006 is supposed to cost about $30 a month. After a $250 deductible, the senior pays 25 percent of the costs up to $2,250. Then comes ‘’the doughnut,'’ with the person paying for all drugs up to $5,100. After that, he or she pays 5 percent.

But individual drug plans vary widely. Twenty-five in Florida have no deductible. Their monthly premiums range from $10.35 for a simple Humana plan (with a $250 deductible) to $104.89 for a Universal Health Care plan (with no deductible).

The drug plans also offer complicated differences in emphasizing generics or branded drugs, with varying co-payments and different lists of drugs and pharmacies that can be used.

But McClellan said consumers may find better alternatives by choosing an HMO that will be offering more drug coverage. He said Medicare HMOs at present save seniors an average of $100 a month in out-of-pocket costs compared to traditional Medicare, and he expected ‘’more extensive benefits and more cost savings'’ for the 2006 HMO offerings.

‘’In South Florida there are many Medicare [HMO] plans that will be offering drugs for zero premium,'’ McClellan said in response to a Herald question.

Humana, for one, is offering a wide variety of options, including six Gold Plus HMOs in Miami-Dade and seven in Broward that have no monthly premium. Most don’t have any deductible on drugs.

AvMed and Vista are among others offering HMO plans with no premium and no drug deductibles. So is CarePlus, which will remain a separate brand in 2006 though it was purchased by Humana.

‘’It’s not as confusing as it looks on the surface,'’ insists Michael Seltzer, who heads Humana’s Florida Medicare offerings. “We’ve constructed these benefits because one size doesn’t fit all. As they go through the process and talk with our advisors, it won’t be confusing.'’

Experts already are worried that some may attempt to take advantage of seniors bewildered by the choices available. ‘’There’s some concern about pressure tactics from marketers and . . . out-and-out scam artists,'’ McClellan said.

No door-to-door solicitations are allowed unless a person has specifically requested a visit. No senior should pay out money before Nov. 15 and no senior should reveal personal information on the phone.

In the complex choices available, experts are sounding two other cautionary notes:

• Seniors who have little or no drug usage should be careful if they’re thinking of not signing up for a drug plan now. If they wait several years and then decide they need drug coverage, they will be assessed a penalty of 1 percent of the average premium a month for the time they didn’t have coverage.

• People who are in an HMO and happy with it should not sign up for a separate drug plan without checking to see what the HMOs are offering for drugs. If someone in an HMO signs up for a separate drug plan, that automatically kicks them out of their HMO.