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Cutting through Medicaid confusion

Unlike many senior citizens who signed up for Medicare Part D last year, Betty Winchenbach said she wasn’t confused by any paperwork she had to fill out or sign.
The confusion came during the paying process.
“I paid my premiums, then got two letters saying that we overpaid,” said Winchenbach. “Money was still drafted out of my account.”
She said the error – now corrected – amounted to a lack of communication throughout the whole signing-up process.
Wickenbach – along with more than 85 seniors – packed a dining room at Capt’n Pete’s restaurant on N.C. 150 last Friday for the monthly Wayne’s Second Friday Feast.
The program featured an explanation on the Medicare Part D program from Caremor Pharmacy owner and pharmacist, Donnie Davis.
According to Davis, 2007 marked the second year in a row for the plan that requires participants to pay an initial $265 deductible. Prescription drugs are then covered at 75 percent through $2,400..
“Medicare set a limit because they couldn’t pay for everyone,” said Davis, adding once the limit is reached – and no matter when it’s reached — participants have to pay 100 percent of their prescription drugs.
More than 35 percent of all participants reach the coverage gap each year, which is $2,401 and beyond. Davis referred to the coverage gap as a “donut hole.”
“At the stage after the coverage gap is ‘catastrophic care,’ where Medicaid will pay 95 percent,” said Davis. “It’s a really confusing system.”
Davis said that for those who don’t spend up to the $2,400 limit needn’t be concerned with the “donut hole.”
“Others who have Medicaid and Medicare don’t have to worry about the coverage gap,” said Davis.
Davis touted assistance that’s available through the Social Security Administration.
“The paperwork is clear-cut as to how much you can make and how much in assets you can have in order to qualify,” said Davis. “Most people get into the coverage gap around July or August. Some go as far as November or December.”
The coverage gap rises six percent each year according to Davis.
Davis added when many seniors get into the coverage gap, they make choices like whether to take a full or half dose of medicine or skip medicine altogether.
Many seniors, according to Davis, then make a mistake in turning to Canada for their medications.
“You don’t know what you’re getting and some drugs may be counterfeit,” said Davis. “It’s a big problem.”
Davis touted a new state program called NCRX, which is based on the same criteria that the SSA uses for low-income people.
“A participant can pay up to $18 of their premium to their insurance company if they qualify,” said Davis, adding monthly premiums to insurance companies depend on the type of coverage seniors use.
Yet another idea Davis touted is the use of generic drugs.
With generic drugs, when a patent expires on a name-brand drug, the drug price drops 20 percent in the first six months; afterwards, the price drops a staggering 500 percent.
“Talk to your pharmacist about generics,” said Davis. “Always ask because they’re just as good as the name brands.”
Davis said he takes generic drugs himself.
“People think I get my prescriptions for free,” laughed Davis. “I have to pay for mine like everyone else.”
Davis was asked by an audience member if there was a penalty for not signing up for a Medicare plan.
“After the 2006 deadline, the penalty was one percent added to your insurance premiums per month,” said Davis. “If you wait to sign up two or three years down the road, the premiums would cost more and not the drugs.”
Davis also shattered the misconception that Medicaid pays for cough and cold medications.
“Medicaid will pay for an antibiotic to make you feel better,” said Davis. “However, they consider cough and cold medicines symptomatic care, so they really don’t care if you cough.”
In 2005, the government threw pharmacists like Davis a curve regarding patient information and their Medicaid accounts.
“We could tell a patient how close they were to their $2,400 coverage limit,” said Davis. “At the last minute in December 2005, the government told us we couldn’t. They threw us a curve.”
Now, Davis said, the only way to find out is through a monthly statement that seniors receive each month.
For Winchenbach, she first learned of Medicare Part D through a library program.
What struck her is that between the speakers invited at the library program, information was changing at a fast pace.
“After each person finished speaking, the next person would say ‘that’s changed,’” said Winchenbach, adding she didn’t really know what was done to get her payment problem straightened out.
“We had to work together to correct and re-correct the issue,” said Winchenbach. “I just have to trust.”
by Jon Mayhew

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