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PRIVATIZATION OF GOVERNMENT INSURANCE

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On November 15, 2005, everyone needs to make a decision about prescription drug coverage. If you don’t use a lot of prescription drugs now, you still need to make a decision!

Part D of Medicare’s new prescription drug coverage is NOT just for seniors! It impacts all consumers on Medicare, all government income programs, including Medi-Cal and the limited-means sector. Know this: your costs WILL vary depending on your financial condition and which drug plan you choose.

WHY THIS IS IMPORTANT TO YOU:

Between the 19 insurance companies, six categories of medications will be covered and all pharmacies will have contracts but not in every plan! This means that you need to pick the plan that covers your medication, your out-of-pocket cost for that medication, and your pharmacy. This also means that you may NOT get all three of your choice.

Medicare has responded by preparing an Internet tool to aide all consumers in picking a plan with the three most important factors in mind as soon as the information becomes available. However, the digital divide most commonly experienced in poverty has not been taken under consideration: lack of means and skill to access the Internet.

On November 8, 2005, there is a Special Election being held in California that will further impact your cost for prescription drugs! Proposition 78 and Proposition 79 are the proposed statutes for negotiating discounts on prescription drugs for the state.

Proposition 78 is sponsored by the drug companies and requires discounts on a voluntary basis only. Proposition 79 is sponsored by consumer and labor groups and requires discounts based on prices and participation in the state’s Medi-Cal program.

What To Do Now:

  1. Apply for financial help if you need it. If you think you cannot afford a Part D plan, or if you’re already having trouble paying for your drugs, take advantage of the programs that are available to help you. Based on your income and assets, you may be eligible for help that lets you pay a much smaller share of costs than other participants, or pay nothing at all. The first step in qualifying for financial help is applying for help.
  2. Gather information about your current health care and drug coverage. Make sure you know what kind of health care coverage you have now. Find out whether you currently have any prescription drug coverage, what kind it is, and whether it will be available after January 1, 2006, when Part D takes effect. You’ll use this information to help you decide whether to keep the plan you have, or move to a Part D plan.
  3. Gather information about the drugs you use. Begin making a list of drugs you regularly take, including their names, and your dosage (for example, 20 milligrams), how much it costs each time you refill the prescription, and how many times a year you refill the prescription. You’ll need this list to help you compare plans later.
  4. Gather information about Part D plans in your area. In October 2005, Medicare will send you the 2006 edition of its annual booklet, Medicare & You. This booklet will give you information about the Part D plans available in your area. You will also be able to find information about Part D plans at http://www.medicare.gov, the Medicare website. You may also receive information in the mail from private companies about their plans.
  5. Compare plans. Once you have information about the plans available to you, compare plans. Making a simple chart can help you compare one plan to another. Here are some of the items you may want to compare: Monthly premium, deductible, what percentage you pay for co-insurance, and what amount you pay for co-payments. You will also want to compare formularies (list of prescription drugs) to see whether the drugs you take are covered by the plan. And check to see where the plan’s network pharmacies are located.
  6. Find out whether you have “credible coverage.” If you are currently enrolled in a plan that offers coverage equal to a Part D plan, you have what is called “credible coverage.” If you have drug coverage now, ask your plan if you have “credible coverage.” If you do have creditable coverage, you won’t be charged a late enrollment fee if you move to a Part D plan after the initial enrollment period (November 15, 2005).

Important Dates To Remember:

October 2005: Private companies begin to release details about what they have to offer, costs and the specific drugs in their formularies (list of medicines).

November 8, 2005: Special Election to vote on Proposition 78 and Proposition 79.

November 15, 2005: First day you can enroll in Part D plan.

January 1, 2006: First day you can use your Part D prescription drug coverage (if you enrolled prior to December 31, 2005).

May 15, 2006: If you are eligible for Medicare, this is the last day you can enroll in a Part D prescription drug plan without a late enrollment fee, unless you quality for an exception (see above). After this date, you must wait until the next open-enrollment period (November 15-December 31) to enroll, unless you have special circumstances.

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Author: Street Sheet Editor

The STREET SHEET is the oldest continuously published street news paper in the United States. Organizationally, it is the public education and outreach tool of the Coalition on Homelessness. Every month, the STREET SHEET reaches 32,000 readers through over 200 homeless or low-income vendors. Our vendors are charged nothing for the papers they receive, and keep all money they earn through STREET SHEET distribution.

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