Date: October 11, 2005
For more information contact: Eileen Mallow, Assistant Deputy Commissioner, (608) 266-7843 or eileen.mallow@wisconsin.gov

Be Prepared for Change Part 1

Madison, WI—As Medicare Part D quickly approaches, Medicare beneficiaries need to consider their options and be informed consumers. Jorge Gomez, the Commissioner of Insurance, is stressing the importance of making an informed decision about the role Medicare Part D will play in paying for outpatient prescription drug expenses. Medicare Part D is the new prescription drug benefit that will begin January 1, 2006, and will provide coverage for a variety of outpatient prescription drugs that have not been covered by the Medicare program in the past. This program will affect nearly 850,000 seniors in Wisconsin alone.

Medicare Part D Prescription Drug Plans (PDPs) will be offered by companies that have been approved by the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the Medicare program. Of the 17 companies offering the drug benefit in Wisconsin, 13 are licensed health insurance companies or HMOs. "Medicare beneficiaries, both new and old enrollees, should verify the experience of the PDP with any Medicare program," says Gomez.

To expedite enrollment into the program, CMS is directing senior advisors and community workers to provide beneficiaries with enrollment information. Some of these individuals have significant Medicare experience, while others have little or no experience advising seniors about the program. "Despite the good intentions of senior advisors, seniors need to receive competent information and advice on this very important coverage decision. Seniors should make sure the person providing the advice knows what they are talking about."

There are a total of 45 PDP plans offered in Wisconsin alone. These plans will be difficult to compare and any senior planning to purchase drug coverage should make certain that the plan meets their needs as well as their budgets. "Medicare Part D PDPs have monthly premiums and may have deductibles, coinsurance, and co-payment requirements. Seniors need to look closely at the formularies to make certain the drugs they need will be covered by the plans and that they are getting the best deal possible."

Seniors should also examine their current drug coverage. Some seniors may have a generous retirement drug benefit, some may be in Wisconsin's SeniorCare Program, and some may have an adequate drug benefit available to them in their current Medicare supplemental policies. Depending on their current level of prescription drug coverage, Part D may not be a reasonable substitute for some of these individuals.

For example, some Wisconsin seniors have Medicare supplement policies that are guaranteed to be renewable and have a limited drug benefit. These same benefits could be provided by a Part D drug plan, but will be subject to the deductible, coinsurance and co-payments associated with the PDP coverage. Also, these seniors who enroll in a Part D drug plan will not be able to reinstate the prescription drug coverage they had under their Medicare supplement policy if they change their mind.

Seniors may also be able to receive their drug benefit through their current Medicare Advantage plans or may enroll in a Medicare Advantage plan that includes prescription drug coverage. Seniors who are not currently enrolled in a Medicare HMO should be aware that some of the plans function through closed panels, meaning that only the services offered by doctors in these plans will be covered by Medicare. If a senior goes outside the plan, they may have to pay for all the costs associated with their treatment. "New enrollees to the Medicare Advantage product could unknowingly give up their own doctor by seeking the drug benefit in this plan because the doctor is not in the network," warns Gomez. In addition, CMS will not require these plans to stay in existence for more than one year should they choose to get out of the program, potentially leaving seniors with a challenging transition in the future.

The Centers for Medicare and Medicaid Services (CMS) has published a listing of the Medicare Part D PDPs that can offer outpatient prescription drug coverage to Wisconsin Medicare beneficiaries. The list of these PDP plans is published in the "Medicare & You 2006" book. Additional information can be found by calling the Wisconsin Prescription Drug Helpline for Medicare Beneficiaries at 866-456-8211 (weekdays) or by visiting the Helpline Web site at www.wismedrx.org.

OCI publications, such as "Medicare Advantage - Questions and Answers," and "Wisconsin Guide to Health Insurance for People with Medicare (2005)," can be ordered free from the agency by writing to OCI Publications, P.O. Box 7873, Madison, WI 53707-7873, calling 800-236-8517 or visiting the OCI Web site at oci.wi.gov.

Created by the Legislature in 1871, Wisconsin's Office of the Commissioner of Insurance (OCI) was vested with broad powers to ensure that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens. Today, OCI's mission is to lead the way in informing and protecting the public and responding to its insurance needs.