New Medicare prescription plan - A Page on Age

By Betsy Zuber

Phyllis Presbrey, an 86 year old Mercer Island resident, feels it's too complicated.

``You need an interpreter to understand this plan,'' she says.

Another Islander, Mary Karaniewski, 81, says ``all these changes and the volume of information that is sent to you makes your head full.''

They're talking about the new prescription coverage offered through Medicare. It starts Jan. 1.

Even people in the business of knowing know the new plan is complex.

``People need to hear or read about the Medicare prescription plan over and over before adequately understanding it,'' says Karin Miller of the Mercer Island Senior Health Center.

To assist Islanders in grasping it, a community informational meeting will be held Thursday, Nov. 3, at Mercer Island Congregational Church. (See box.)

Medicare is a health insurance program for people 65 and older, people under age 65 with certain disabilities and individuals with end-stage renal disease. Medicare has Part A, hospitalization insurance, and Part B, medical insurance. Now Medicare is offering prescription drug coverage, which will be called Part D.

Next month people who receive Medicare will have a chance to sign up for the new prescription plan. Open enrollment starts Nov. 15, 2005, and ends May 15, 2006. Medicare recipients who have private secondary insurance with prescription coverage that mirrors or is better than Part D may not have to buy Part D. These people should have been notified by their secondary insurance carrier already that they will continue to be provided the prescription coverage. Examples of these secondary insurances are Boeing retiree insurance and Group Health.

So here is how the plan will work. You will have to pay a monthly premium, which in Washington will range from $6.93 to $65, depending on the plan you choose. In the standard plan, Medicare covers 75 percent of drug costs, up to $2,250, after a yearly $250 deductible. If the total amount of your drugs is more than $2,250 per year, Medicare will not cover any more until you reach $5,100 in costs. After that point, Medicare will cover 95 percent of the cost. This is called the coverage gap, also referred to as the ``doughnut hole.'' Also, each plan will have its own list of drugs that are covered. People need to choose a plan that best fits the drugs they take now and that also will cover drugs they may need in the future.

There is a late enrollment penalty if you do not choose a plan during open enrollment. The penalty is 1 percent of the premium for each month you delay. This does not apply to people who currently have private prescription coverage and in the future are dropped from their plan or the plan stops providing that coverage.

Extra help is available to people with an annual income below $14,355 for an individual or $19,245 for a married couple, and whose resources are limited to $10,000 and $20,000, respectively. (A house or car is not counted as a resource.) If you meet the criteria, you can apply online at or call 800-772-1213 for assistance paying monthly premiums, deductibles and co-payments under the prescription drug program.

Betsy Zuber, a geriatric specialist, has been working in the field of aging for 15 years. You can contact her at 236-3525, at, or by mail at MIYFS, 2040 84th Ave. S.E., Mercer Island, WA 98040. Mercer Island Youth & Family Services is a department of the City of Mercer Island.

Making sense of Part D

A community informational meeting about the new plan will be held Thursday, Nov. 3 at Mercer Island Congregational Church, 4545 Island Crest Way, from 4 to 6 p.m.

You also can look up information at the Web site,, call Senior Rights and Assistance at 448-5720, or call Zuber.

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