Medicare Unveils Drug-Discount Card Program

Seniors will have to do some homework to find the right card for them

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HealthDay Reporter

TUESDAY, June 1, 2004 (HealthDayNews) -- Today's the day the new Medicare-approved drug-discount card program takes effect. But so far seniors haven't rushed to sign up.

Medicare officials and private card sponsors say it's not surprising that beneficiaries would hold back. After all, it's a new offering, it's voluntary, and there's no penalty for enrolling after June 1.

Senior advocacy groups, however, point to other factors keeping many seniors on the sidelines.

For one, it's likely many older Americans will have trouble navigating the complex enrollment process. Nationally, 28 private sponsors are marketing a total of 77 Medicare-approved drug discount cards. In some markets, beneficiaries will have to sift through dozens of cards to find the best deal for them.

Getting accurate information also has been a problem. Some people trying to reach the government's toll-free hotline, 1-800-Medicare, report frustratingly long wait times to speak with a customer-service representative.

And while Medicare's Web site offers online tools for examining various discount card options and drug prices, frequent changes and updates to that information in the weeks leading up to the program's launch have made it difficult to make accurate comparisons.

Most beneficiaries still aren't aware that the program even exists, said Robert Hayes, president of the Medicare Rights Center, a New York City-based nonprofit organization that is helping beneficiaries navigate the system.

Federal officials have responded by taking steps to provide better data, speed up response times and improve outreach to beneficiaries.

Now that the program is under way, many seniors may be asking themselves whether they should sign up. For starters, here are some basic facts you need to know about the program:

  • Most Medicare beneficiaries are eligible for the discount card. There's one exception: Seniors who have outpatient prescription-drug coverage through Medicaid are not eligible to enroll.
  • Signing up for a Medicare drug discount card is voluntary. If you choose to enroll, you may only sign for one card at a time.
  • The cards are available through private companies, including insurance companies, pharmacy benefit management firms, and large groups of pharmacies. Only those companies that have met government standards for participation may market a "Medicare-approved" drug discount card.
  • The cards are good through Dec. 31, 2005. They are intended to provide temporary help with drug costs while Medicare prepares to launch a new prescription drug benefit on Jan. 1, 2006.
  • Card sponsors may charge a maximum enrollment fee of $30 per year, but many cards have lower fees or no fee. You will have to pay the fee every calendar year. That's a maximum $60 out-of-pocket cost if you participate in 2004 and 2005.
  • The discount cards are not insurance and are not a substitute for any insurance policy you may have that covers outpatient prescription drugs.
  • The cards can save you an average of 11 percent to 17 percent on brand-name drugs and 30 percent to 60 percent on generics.
  • If your annual income in 2004 is no more than $12,569 if you are single, or no more than $16,862 if you are married, you may qualify for a $600 credit per year to help pay for your prescriptions.

Because of that credit, low-income seniors are likely to benefit the most by signing up for a Medicare discount card. Seniors who meet the income test are urged to apply promptly if they want to take full advantage of that assistance.

The card is also likely to help people who don't have any outpatient drug coverage and currently pay full retail prices for their drugs.

On the other hand, the card may not be for everyone. For example, seniors who have insurance that covers outpatient prescriptions may not need the card, some experts say.

"If you have employer-based retiree coverage, say a $2.50 or $5 co-pay, then the discount's not going to be relevant to you," said Gail Shearer, director of health policy analysis in the Washington, D.C., office of Consumers Union.

And if you live in a state that offers a generous prescription drug assistance program, such as New York or Pennsylvania, you're not likely to get a better deal through Medicare, senior advocates point out.

"Almost always those benefit packages are stronger than anything having to do with the discount card," Hayes noted.

To compare cards and decide for yourself, contact Medicare by calling 1-800-Medicare (1-800-633-4227) or visiting www.medicare.gov. Your local pharmacy also may help you get in contact with the sponsors of the drug cards they accept.

For help getting information or wading through the details, contact your local community center, Area Agency on Aging (AAA) or State Health Insurance Assistance Program.

Sandy Markwood, chief executive officer of the National Association of Area Agencies on Aging, said AAAs across the country are being inundated with calls from older adults and their sons and daughters who are confused and want help walking through the process.

"We want to make sure to the extent possible that people make the best-educated decision," she said.

More information

The Centers for Medicare and Medicaid Services has several publications to help answer consumers' questions about the Medicare drug-discount card program.

SOURCES: Gail Shearer, director, health policy analysis, Consumers Union, Washington, D.C.; Robert Hayes, president, Medicare Rights Center, New York City; Sandy Markwood, chief executive officer, National Association of Area Agencies on Aging; Centers for Medicare and Medicare Services Web site

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