“Navigating Medicare Part D” By Katherine Narbonne-Mirchin M.B.A In the ALS community, Medicare plays a big part in our patients’ lives as anyone with the diagnosis is eligible immediately for the program, bypassing the 24 month waiting period. ALS changes the lives of the patients in many ways, health wise and financially. Medicare provides a stable form of health insurance to many people as they and their families cope with the impending changes that ALS brings. In the summer of 2003, Congress approved the Medicare Part D addition. Part D is the first major extension of the Medicare program since its creation in 1966. It provides drug coverage for all subsidiaries of Medicare. For people without any prescription drug insurance, this new addition will pay for 95% of all prescriptions for the patient. However many beneficiaries are having difficulty with the program due to the complex language and general confusion. For people who are having problems understanding the program take a deep breath and remember a few things. First the deadline to select a program is not until May 15th, 2006. No one will be penalized until May 16th and this does not include people who have recently joined Medicare. However if you choose to join after May 15th, there will be a 1% penalty until the next calendar year. Also this year is the last year to join Part D during any point in the year. Each year after 2006 Medicare will allow the beneficiary only 60 days to join part D. The second thing to remember is that this program is not mandatory. People can choose to sign the waiver if they feel that their current prescription plan is adequately fitting their needs. As each person’s situation is different they need to evaluate what is going to work for them. Here are some simple steps that the you can consider to assist in making that decision: Social workers have a wealth of knowledge regarding the plans and can direct beneficiaries on making decisions. They can help people better navigate the website and make a comparable list of the better plans. Most community centers and local clinics have social workers who are ready to help with prescription plans. Anyone who is thinking of changing their prescription plan should speak with their doctors first. It is important to know if any generic medication can be substituted for a brand name one. Generic medication is often less expensive then the name brand therefore the cost is less. Some drug companies may only pay for a generic medication and expect their members to pay the full price on the designer ones so it is important to ask your doctor if the generic medication will have the same effect or what side effects there are before making any decisions. Utilize the Medicare website at www.cms.gov. The site is easy to use and provides a search engine (Prescription Finder) that allows the beneficiary to compare at the plans available to them. A search ran on Medicare found over 200 programs in New York State. All searches are based on a person’s location and prescription needs to narrow down plans. After entering your specific Medicare information in the Prescription Finder, the user can compare plans and see if their pharmacies participate. A beneficiary can also use the Prescription Finder to enroll. If a person is not computer savvy, calling the Medicare hotline is a good alternative that the experts have recommended. It will provide exactly the same information as the website and the customer representative can help anyone enroll. If anyone is still having problems go to the pharmacy. The pharmacists know what coverage different plans offer. Many of them have been providing information from prescription plans that participate with their stores. All people need to remember, again, that this program is not mandatory. There are people who are signed up with HMO programs or have insurance policies from their employers that provide adequate, inexpensive coverage. People with Medicaid are already receiving aid for their medication and with the proper authorization are not paying for them. Medicare Part D was created specifically for beneficiaries who do not qualify for Medicaid and have no prescription benefits.