Medicare Rx Drug Plan: Final Call

Last Chance for Seniors to Sign up Without a Penalty

From the WebMD Archives

May 12, 2006 -- Monday marks the deadline for Medicare beneficiaries to sign up for prescription drug benefits.

The deadline has left some seniors scrambling to select coverage, a decision which in some states means choosing between more than 60 options.

Confusion has led to calls in Congress for a deadline extension. But Republican lawmakers -- backed by President Bush -- have made it clear that that won't happen. Instead, Bush and health officials have spent the last week on a final push encouraging seniors to sign up.

Medicare says more than 37 million of Medicare's 43 million beneficiaries have drug coverage.

"I believe it is a good deal for America's seniors. It's very important for people to understand that there are significant savings for you involved in this plan," Bush said in Orlando, Fla., this week.

The government's figures leave about 6 million eligible seniors and disabled yet to enroll in a plan. Critics accuse the administration of pumping up the figures by assuming millions of seniors eligible for other drug plans like the VA's are using them.

"The numbers just don't add up," Diane Archer, founder of the Medicare Rights Center, tells WebMD. Her group estimates the actual number of unenrolled beneficiaries at 10 million.

What You Can Do

Either way, there are millions of eligible U.S. seniors who won't have Part D by Monday at midnight. Most who don't will face a penalty equaling 7% of their premiums by the time the next round of coverage begins in January 2007.

Only some low-income seniors who also qualify for extra Part D subsidies may be exempt from penalties for late sign-up.

Seniors without a plan can still cut costs in the meantime, says Gail Shearer, director of health policy at Consumers Union.

Shearer urges seniors to look for generics and other cheaper versions of drugs they take. Her group has released "best buy" guides for 13 popular drug classes, including cholesterol-lowering statins, blood pressure drugs, and asthmamedications.

"People do have drug options that vary dramatically in cost and not so dramatically in effectiveness, and it can save them a lot of money," she says.

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Company Charity Programs

Meanwhile, several drug makers have announced that they would continue charity programs providing free or discounted drugs to low-income people. Many companies had previously decided to cut off the programs for eligible seniors after May 15.

Legal questions were swirling in Washington about whether the programs could go forward without violating federal antikickback laws. But a ruling concluded that the plans can indeed go on.

Companies including Schering-Plough, AstraZeneca, Eli Lilly, GlaxoSmithKline, and Johnson & Johnson have all said their plans will continue. Pfizer and Bristol-Myers Squibb have not yet decided if they will keep their programs, a Senate aide tells WebMD.

Each company's plan is different; low-income seniors wanting to take advantage of the programs have to apply to each manufacturer separately.

Ian Spatz, Merck's vice president for public policy, says his company provides free drugs for seniors living at up to 400% of the federal poverty level. But coverage lasts only until January. "Then they might apply to us again," he says.

Bill Cunningham, director of the West Virginia Access to Benefits Coalition, notes that seniors questioning whether assistance will continue must contact companies individually to find out.

"If you as an individual can prove to most of the patient-assistance programs that the cost of your medical Part D program is more than you can afford, they will continue to provide you the product," he says.

Penalty Repeal?

Meanwhile, a growing number of lawmakers are signaling that Congress could revisit Medicare after the deadline passes and repeal penalties for late-comers next year.

Several Republicans tell WebMD that they support repealing financial penalties. Unenrolled seniors will begin a new sign-up period in November -- within a week of Congressional elections.

"I wouldn't be opposed to trying to help people out in that way," Rep. Rob Bishop, R-Utah, tells WebMD. "But, for obvious reasons, people shouldn't take that as something to take to the bank."

WebMD Health News Reviewed by Louise Chang, MD on May 15, 2006

Sources

SOURCES: President George W. Bush. Diane Archer, founder, Medicare Rights Center. Gail Shearer, director, health policy, Consumers Union. Ian Spatz, vice president for public policy, Merck & Co. Brian Cunningham, director, West Virginia Access to Benefits Coalition. Rep. Rob Bishop, R-Utah.

© 2006 WebMD, Inc. All rights reserved.

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