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Making Medicare Work for You

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Making Medicare Work for You

By: Congressman Lamar Smith

Medicare was created in 1965, a time when doctors treated most serious ailments with surgery. Thanks to advancements in medical technology, today's doctors are able to treat many illnesses with a prescription instead.

Unfortunately, Medicare has not kept up with modern medicine. For over 40 years, the program has failed to offer America's seniors meaningful assistance with their drug bills.

This January, the program finally began offering seniors comprehensive prescription drug coverage known as Medicare Part D. The addition of Part D is the biggest change to Medicare since its creation over four decades ago.

But like any new program of this magnitude, Medicare Part D is raising questions. Seniors want to know, "Am I eligible? Will I lose my current coverage? Does it cover the medications I need? How do I enroll?"

First, the new Medicare prescription drug benefit is available to all Medicare beneficiaries regardless of their income, health status or location.

Second, enrollment in the program is completely voluntary. You must choose to sign up. If your employer's coverage is better than the coverage offered by Medicare, you can keep your current plan. If Medicare coverage is better than what you currently have, you can switch.

But those who wish to enroll in Medicare Part D are encouraged to do it as soon as possible. The initial sign up period for Part D ends May 15. Medicare-eligible seniors who do not sign up before the deadline will face penalties of 1 percent increases on their monthly premiums.

Not everyone will face a penalty. Seniors who have drug coverage through another source, such as their former employer or a union retirement plan, are not penalized if they later decide they want to join Part D.

Medicare Part D is not a one-size-fits-all program. Beneficiaries in Texas have a wide range of options to consider. Twenty-one providers are approved to offer Medicare prescription drug coverage in our state. Each provider must cover both generic and brand-name drugs and be accepted by local pharmacies.

The amount of money you pay in premiums, co-pays and deductibles varies by plan. In Texas, premiums vary between $10 and $68 a month. For most plans there is a $250 yearly deductible, after which Medicare pays approximately 75 percent of a senior's drug costs, up to $2,250 a year. Once your yearly out-of-pocket drug costs reach $3,600, Medicare will cover 95 percent of the remaining costs.

Some beneficiaries may be eligible for additional help, depending on their annual incomes. Those with the lowest annual incomes pay no premiums and deductibles. You may qualify for this assistance if you are single and have an annual income below $14,355, or if you are married and have an annual income below $19,245.

With so many options and so many levels of assistance, the enrollment process can seem overwhelming. But you don't have to do it alone. There are several resources available to help you or your family member navigate the system.

One of the easiest ways to enroll is by telephone. To do this, you must dial the Medicare hotline at 1-800-MEDICARE. A trained professional will answer your questions and walk you through the enrollment process.

Before you call, make a list of the prescription drugs you are currently taking. The list should include the names and doses of each medication. Having this information handy will help you and the operator compare the various plans and decide which one best meets your personal needs.

You should also be sure to have information about any prescription drug coverage you currently have. This could be a union-sponsored plan, an employer-sponsored plan, or a Medigap policy. The Medicare operator may also ask you for the name and address of the local pharmacy you use, the amount of money you spend out-of pocket on prescription drugs each year and your Medicare enrollment information. Knowing this information before you call will help you and the Medicare operator decide which plans offer you the best deal.

The Medicare hotline is available 24 hours a day, seven days a week.

Seniors may also enroll in the program through the Medicare website by logging onto The site's on-line comparison tool allows you to examine the different plans available in your area and decide which one best fits your needs. As with the telephone enrollment option, make sure to have handy a list of your current drugs, local pharmacy and information about any other drug coverage you are recieiving.

If you need additional help understanding the enrollment process, please visit my offices between the hours of 9 a.m. and 5 p.m. The Austin office is located at 5608 Parkcrest Drive, Suite 260, and the San Antonio office is in the Guaranty Bank Building located at 1100 NE Loop 410, Suite 640. The 21st Congressional District staff is ready to help answer constituent questions about the new Medicare Part D benefit.

Thanks to the addition of Part D, Medicare better reflects the needs of today's seniors. The health care system will continue to change, and I look forward to seeking solutions so that all Americans have access to affordable health care coverage.

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