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 February 2006 Back to Table of Contents Back to Archives Main Page Section: Being Well Medicare D: A Test Case By Kristin Surdej, Certified Care Manager at Toby Laping Associates. My grandmother graciously allowed me to use her information as a test for Medicare D. She has EPIC (the New York State prescription plan for seniors) and does not need to select a Medicare Prescription Plan because EPIC is considered “Credible Coverage.” However, it is wise to consider a plan to complement EPIC’s coverage. That may not be easy because EPIC allows more than 30-day supplies on some prescriptions for a single copay while Medicare Part D plans may not allow that. Using the Medicare web site (www.Medicare.gov), the vast amount of information can be overwhelming and hard to navigate. I entered grandma’s personal information and medications and was surprised at the number of options available; the program did not narrow them down. I was hesitant to use the option to limit the search by entering restrictions on the deductible or monthly premium for fear of ruling out plan options I should be considering. The deductible costs ranged from $0 to $250 and premiums ranged from $4.10 to $59.39 a month. The column “Monthly Cost Share,” ranging from $171.11 to $1,013.38, left me confused. I was told to select “View Cost Details” for more information. However, nowhere on the screen could I find “View Cost Details.” I finally found it under “Plan Information” and then “More About This Plan.” It is a necessary next step to view the details of the plans to be considered, either individually or by selecting up to three plans for comparison. As I mentioned earlier, grandma has EPIC and the system does not take that into consideration. I needed to calculate by hand the cost of the various medications considering EPIC’s coverage AFTER the Medicare Plan coverage. Then, unsure if I was making the best plan selection, I called the toll free phone number (1-800-633-4227). After navigating through a confusing maze of phone menu options, I finally reached a helpful, patient, good humored individual. I was asked my name, zip code and phone number and also gave grandma’s personal information. I said grandma has EPIC. Then we proceeded with the list of medications, dosages, quantity and pharmacy of choice. I was not asked about any personal limits regarding deductibles or monthly premiums. The representative gave me details on two plans the system said were most appropriate, one of which I had also found through my internet search. I asked how EPIC coverage was factored in and was told the system does not consider that. I asked about the next step. The representative said she could enroll grandma any time via the phone, and she also gave me phone numbers to contact each plan directly. She gave me a confirmation number as a way to save the information we had used during the phone conversation. I was told this would eliminate the need to give all the information again if we called back to enroll in a plan. The entire phone call took 16 minutes on a Sunday morning. This is a very individualized process based on specific information that varies with each person. I am not going to sign grandma up for a plan now. Instead I will take a few months to let the system mature a bit. In the meantime, I will contact her pharmacy to confirm copay costs. And, I will call EPIC and our plan of choice to confirm coverage details and costs. www.wnycaremanager.com back to top back to table of contents Current Issue | About Forever Young | Where to Find | Advertise | Our Advertisers | Community Calendar | Contest | Clubs | Contact Us | Archives | Home |