Benefits baffle seniors

One aspect that shocked many seniors was the late enrollment penalty. If seniors wait to enroll in the new benefits, a 1 percent base premium will be added each month. Enrollment begins Nov. 15 and ends May 15, 2006.

"I'm very afraid of it," said Clara Martin, a Salt Lake senior. "If you're going to be penalized, I thought I had to sign up today. . . . It feels like you're going to lose out on everything if you don't sign up. I don't want to give up what I got if it's not going to be better."

Specific plans for Medicare Part D will not be available until October, when Medicare will allow companies to start marketing the various plans. The new benefits are optional.

"It is not a free program," stressed Sally Anne Brown with the Utah Division of Aging and Adult Services. "The insurance company will provide them (prescription drugs) to you."

In addition to a monthly premium of $32, beneficiaries will have to pay an annual deductible of $250 and a $3 co-pay on generic drugs, and a $5 co-pay on brand-name drugs. Medical expenses will be covered by Medicare for 75 percent of drug costs up to $2,250 — the amount the average senior spends on drug coverage annually.

However, beneficiaries will face a coverage gap, dubbed "the doughnut hole," between $2,250 and $5,100 of expenses, where they will have to pay 100 percent of costs. Over that, Medicare will cover 95 percent of prescription costs. These expenses apply only to those not living at the federal poverty level.

Brown told seniors to learn what coverage they currently have, something she said many seniors do not know. She listed eight tips for seniors wanting to learn more about Medicare coverage:

• Do not rush at this point because all the plans are not available.

• If a plan doesn't have a monthly premium, that doesn't mean it's the best plan for you.

• Will your doctor take the new prescription plan?

• What will be your total out of pocket expenses?

• Have somebody help you decide on a plan.

• Ask a lot of questions to make sure you are satisfied with a plan.

• Examine your lifestyle. If you travel a lot or have a summer or winter home, make sure the plan covers you everywhere.

• "Remember: If it's too good to be true, it probably is."

Michelle Posselli, constituent service representative with Matheson's office, said, "We realize it might be a little confusing to people," and Matheson wanted to bring in regional officials to speak to the seniors because the representatives are "really more knowledgeable about the particulars than he is.

"The main reason the congressman voted for the new law is because he thought it was important to provide some prescription drug coverage for so many seniors who don't have any coverage at all," she said. Posselli added that although he would have preferred other versions of the act, "he thought it was important to provide something."

For free Medicare counseling from the Health Insurance Information Program, visit www.hsdaas.utah.gov or call 1-800-541-7735. Posselli's office is also available to answer questions concerning the new plan, at 468-1236.

More information is also available at www.medicare.gov or by calling 1-800-MEDICARE.

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E-mail: astowell@desnews.com