The ABCs (and D) of Medicare: St. John’s Seniors program can help sort it all out

The Medicare Prescription Drug Improvement and Modernization Act of 2003, which was signed into law in December 2003, makes major changes to Medicare. These changes include a new voluntary prescription drug benefit, changes to the program that deal with private health plans, new coverage and cost increases.

“The most important part of the law is a new benefit to help people in Medicare with their prescription drug costs, also known as Medicare Part D,” says Valerie Griffin, coordinator of St. John’s Seniors.

In addition to the drug benefit, Medicare will cover some preventive medical procedures in 2005 under Part D.
The prescription drug assistance goes into effect in two stages. The first stage began last May, when qualifying Medicare recipients began signing up for discount cards to help them with some drug costs. The discount-drug card program is a temporary program that will phase out when the second stage of assistance, a voluntary Medicare drug benefit, goes into effect on Jan. 1, 2006. If your income is low, you can get additional help, Griffin says.

“Medicare contracted with 46 private drug companies to provide these discount cards,” Griffin says. “The cards can save qualifying Medicare recipients about 10 percent to 15 percent on their total prescription drug costs."
The key is to figure out which card best meets your needs and gives you the best deal. You should sign up for the card offered by the pharmaceutical company that manufactures the majority of your medications, in order to get the maximum discount. Discounts vary by card, and each plan is slightly different.

How St. John’s Seniors can help

St. John’s Seniors operates a CLAIM site, which is a volunteer-based program developed to assist seniors with their insurance claims. Trained volunteers can answer Medicare recipients’ questions about coverage and help recipients apply for the discount cards. Please call the CLAIM (Community Leaders Assisting the Insured of Missouri) line at 1-800-390-3330 to set up an appointment.

2005 Medicare Changes / Cost increases

Part A (hospital insurance)

• Premiums: $206 per month for those who have 30-30 Social Security work quarters and $375 per month premiums for those who have fewer than 30 Social Security work quarters.
• Inpatient hospital deductible: $912/day (days 1-60)
• Hospital co-payment: $228/day (days 61-90)
• Lifetime reserve co-payment: $456/day (days 91-150)
• Skilled nursing co-payment days: $114/day (days 21-100)

Part B (medical insurance that covers doctors' and outpatient hospital services, physical and occupational therapists and some home health care)

• Premiums: $78.20 per month
• Deductible: $110

Part D (New prescription drug benefit, plus coverage for preventive screenings and tests)
Beginning in 2005, Medicare will, for the first time, cover preventive procedures, including:

• A one-time initial preventive physical exam within six months of when a person with Medicare first becomes enrolled in Medicare Part B;
• Screening blood tests for early detection of cardiovascular diseases;
• Diabetes screening tests for people at risk for diabetes.