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Seniors can switch Part D drug plan

Senior citizens in New Jersey should get ready for Round II with Medicare Part D.

Open enrollment begins today, and seniors can start analyzing the deductibles, premiums and restrictions of 57 prescription drug plans offered in the state -- 13 more than last year.

Seniors and disabled people on Medicare can sign up for the first time and get coverage for 2007. Or those already on a plan can switch to a different one for next year. Open enrollment lasts until Dec. 31, but federal officials say anyone who wants a drug card up and running by Jan 1, 2007, will need to sign up by Dec. 8.

After a year of real-world experience, many Medicare recipients will approach this second open enrollment period with caution.

"Seniors have a better understanding of what the hassles can be because they've already run into them," said Al Roesch, a Flemington resident volunteer who counsels people about Part D at the Hunterdon County Senior Center.

The first-ever federal drug prescription coverage for Medicare recipients began Jan. 1 of this year. The complexity of the program and its rocky rollout frustrated many seniors, who found navigating the Medicare Web site difficult and the choices confusing. Officials at the Centers for Medicare & Medicaid Services said enrollment should run more smoothly this year.

"The training of staff has been beefed up to a considerable extent," said Gilbert Kunken, acting regional administrator for CMS. He said the plan-finder tool on the Web site (www.medicare.gov) now is easier to navigate.

Kunken said monthly premiums are about the same as last year, on average $24, and that plans have increased the number of covered drugs by 13 percent. More than half the plans in New Jersey now have a zero deductible.

More plans will cover generic drugs during the so-called doughnut hole, or the gap in coverage after people purchase $2,250 worth of drugs. Coverage drops to zero and does not kick back in until the person hits $5,100 in drug expenses. Then Medicare covers 95 percent of the cost.

Many seniors stunned by how quickly they hit the doughnut hole will find more options this year for coverage through the gap. Last year six plans offered coverage through the gap. This year, 16 plans will offer it. One is Horizon Blue Cross Blue Shield of New Jersey.

This gives members some level of additional coverage without increasing premiums significantly," said Keitha Lackey, Horizons sales director of consumer and senior markets. The Horizon plan with generic doughnut hole coverage costs $35.70 each month.

Just one company, SierraRx, offers a plan with both generic and brand-name coverage through the doughnut hole. Premiums are hefty, however, at $135.70 each month -- the highest in the state.

Deane Beebe, a spokeswoman for Medicare Rights Center, a Washington-based advocacy group, said even people satisfied with their current plan should analyze the new options. Plans change, she said, as do people's drug needs. Insurers are required to notify consumers about any changes as their plans move into 2007.

She said the program remains complex.

"We're back where we started from," she said. "Medicare recipients are forced to wade through dozens of plans all with limited coverage and none of it guaranteed. The problems will continue."

The 57 plans are stand-alone, meaning they just provide drug coverage. But this year, insurers also are pushing their Medicare Advantage plans, which combine Medicare coverage for doctors and hospitals with drug coverage. These plans generally have lower out-of-pocket expenses, but they may limit patients to a network of doctors and hospitals. "We simplify our program to give people access to Part D and medical benefits together," said Rick Jelinek, CEO of SecureHorizons by United Health Care.

Also available are special-needs Medicare Advantage plans for the chronically ill. One available in Monmouth, Ocean, Middlesex and Somerset counties by QMedCare of New Jersey provides comprehensive medical coverage, including doctor and hospital coverage, along with drug coverage. Out-of-pocket costs are low, according to Bob Mosby, a spokesman. In order to enroll, people must suffer from congestive heart failure, stroke or coronary artery disease.