Understanding Medicare Prescription Drug Coverage

Problem:
Forty-two insurance plans now are available to Iowa residents to help Medicare clients with their prescription drug costs. Individuals must first decide if the plans will reduce their costs and what plan will provide the best coverage. Tools to help individuals with their comparisons and decision making are available on the internet. The elderly do not have computers or the skills needed to use the available tools. 

Response:
Health care providers in communities were contacted to determine if there was a need for education about the new prescription drug coverage program. Public Health in Taylor County requested a review of the new insurance program and indicated that there was a need for one on one counseling for elderly residents. Wayne, Lucas, Ringgold and Decatur Counties also indicated interest in providing time for individuals to learn more about their options and receive access to the internet to use the comparison tools. To date, two days have been spent in Taylor, six in Ringgold, two in Lucas, two in Wayne and two in Decatur County meeting with 130 individuals to use the Medicare web site and answer their questions about the new insurance coverage. Two additional days are scheduled in Wayne County and two in Adams County in January.

Impact:
Twenty-eight individuals were encouraged to complete and file applications to request additional assistance from Social Security to pay all or a part of their premiums for coverage.  “Will I lose my home and savings if I request this help?” asked Mary. She was relieved to learn that the assistance would not require her to forfeit her assets. Calculations for a majority of the clients showed an out of pocket savings of 50% for their prescription drug costs if they selected a policy. One of my first appointments was with an individual who was deeply concerned that she could not spend any more money for insurance or medicines. Calculations showed her current out of pocket costs and what the costs would be if she purchased a policy. She was delighted to learn that she could purchase a policy and save $1,300 during the coming year if her medications remained the same. “Thank you, I understand this better now.  I’m going to see if my neighbors will come in for a visit.  They are just as confused as I was!” she stated.

Medicaid patients, who had been randomly assigned to a plan, were able to find out what medications were covered in the plan formulary and, if necessary, find a policy that would offer better coverage. Three individuals learned that the new policies would not be as beneficial as the discount cards they currently had and decided to wait until later in 2006 to purchase a plan when the cards expired. Two individuals learned that their current prescription drug plans provided a more complete coverage and decided to continue paying the additional premiums. Jane was using three drugs during 2005 for a total out of pocket cost of $9,500. The Medicare tools indicated that the cost could be cut to $1,000 to $4,000 by purchasing a plan. Jane and others like her were relieved to learn they would have cash available for other living expenses in 2006. 

Contact:
Joyce Lash
Field Specialist, Family Resource Management
101 North Polk, Mount Ayr, Iowa  50854
Phone 641-464-3333; Fax 641-464-3333
Email lash@iastate.edu