Guest commentary: Navigating bewildering Plan D seas

Exposure of the new Medicare Prescription Drug Program by the Daily News (Sunday, May 28) describing the financial impact of the plan's coverage gap or "doughnut hole" on "low-income seniors" — loosely defined as those singles with assets (other than a home) under $11,500 and a monthly income of $1,196 and married couples under $23,000 in assets and $1,603 monthly income — deserves further illustration and some sage advice.

Even with higher assets, the new Plan D can be devastating on the cash flow of those seniors on a fixed income and whose monthly prescriptions run high.

Consider that 22 percent of all senior citizens age 65 or older have diabetes.

Two commonly prescribed insulins, Novolog and Lantus, run over $400 (retail) a month. That tab doesn't include necessary supplies or preventative drugs that could help minimize the disease's effects.

Seniors with $500 (retail) monthly drug costs will go nearly six months in the "doughnut hole" paying the full retail amount (plus premiums) until the "catastrophic level" kicks in.

Setting aside the future taxpayer ramifications of Plan D, focus on even more financial realities for our seniors. Premiums — for Medicare, Medicare Supplement and Plan D — most certainly will increase annually, as will Medicare Parts A, B and D deductibles. The law forbids Medicare to negotiate discounts with pharmaceutical companies, making increased drug costs inevitable. Providers need only give 60 days notice of formulary (covered drugs) changes.

Before these financial certainties occur, however, seniors must go through the exhausting — and yes, frightening — labyrinth of individual plan selection. It's estimated there are over 1,400 stand-alone Part D plans, considering state-by-state, company and plan offerings.

It's completely heartbreaking to know there are seniors who are alone, have cognitive challenges, are physically handicapped and/or who have little or no working knowledge of the Internet and spreadsheets. As you stated, "Many seniors will face the coverage gap unaware of its existence."

Unexpectedly, my husband and I had to face selecting a Medicare Supplement Plan and a Plan D for him, coinciding with the May 15 enrollment cutoff date for those already on Medicare.

We spent untold hours, first learning Plan D basics, then pouring over brochures and formularies, talking with our pharmacy staff and Social Security, asking others what they had selected, attending seminars, setting up comparison spreadsheets and surfing the Internet. I am so thankful we are marketing savvy, computer literate and excruciatingly tenacious.

Some provider representatives were helpful; the norm, however, was interminable holds on the phone, misinformed agents, conflicting explanations of the "doughnut hole," reluctance to supply formularies, "counselors" whose English was barely understandable, incorrect published phone numbers and sometimes total disinterest and/or patience by telephone representatives.

As it turned out, the computer was our best friend. One of the best tools available is the Medicare Prescription Drug Plan Finder on the Medicare Web site (www.medicare.gov), allowing side-by-side comparisons of plans. Be prepared to enter the name of each drug used and in what form, its dosage/strength, the quantity taken each day or week, and current retail cost.

Still, with all our preparation, my husband enrolled — online to avoid an "in-home interview" — with fingers crossed that we had picked the right one.

If you're now enrolled in a Part D plan, don't stop your research and comparisons. Also carefully track your expenditures and costs; many pharmacies and plan providers offer helpful online records.

Plans will change, possibly for the better as providers compete for business, while others may fold completely. The "Annual Coordinated Election Period" runs from this Nov. 15 to Dec. 31, and every year thereafter. Plans and/or providers can be changed altogether.

If you're currently a Medicare beneficiary and not enrolled, think about doing so next enrollment period. Even if you currently take no prescription drugs, review lists of the most commonly prescribed drugs, plan costs and formularies. There are penalties for each month you were entitled to enroll and did not.

If you're planning to retire in the coming months and counting on Medicare, start your research and information gathering now.

If you're approaching retirement (65) and counting on Medicare, but have no immediate plans to retire, refer to the paragraph above. Life has a way of throwing unexpected curves.

Oh, and one more thing: The fallout from Plan D is not over — it's just beginning. If you know a senior who, for any reason, can't use the computer to aid in research and decision support, give a helping hand. Every senior deserves every bit of available help.