CONSTITUENT SERVICES

HHS Secretary Mike Leavitt and Congressman Michael Burgess watch as citizens get signed-up for the new Medicare Prescription Drug Program at an event in Fort Worth.

MEDICARE Prescription Drug Enrollment Deadline is MAY 15th

Texans Enjoying Medicare Rx Savings
Op-Ed by Congressman Michael C. Burgess, M.D

All through the last several months there have been some big changes occurring in Medicare, changes which have been 40 years in the making. For the first time since its inception, Medicare now has available a prescription drug benefit.

Original Medicare, back in the sixties, covered hospital bills and doctor charges. There was no provision for covering a patient’s prescriptions. While this may have been a pardonable oversight in 1965, it is an unforgivable omission given the circumstances of modern medicine in the 21st century. The whole premise of today's medical care is to treat and manage chronic illness and prevent recurrent hospitalizations.

Politically it had been difficult to add this benefit because of the costs involved. Many Congresses and several Administrations considered the addition of a prescription drug benefit, but it was not until 2003 that the legislation was actually passed. The benefit became effective on January 1 and the open enrollment period will conclude on May 15.

An original criticism of the Medicare modernization act was that no insurance company was likely to be interested in participating in the prescription drug plan. However, in Texas, over 20 separate companies have combined to offer over 45 plans. The criticism now becomes that there are too many plans and that that the system is too complex for people to make a rational and informed decision.

Today seniors are members of the greatest generation that group of people that survived the great Depression, beat back the global fascism, and created the greatest economy the world has ever seen. I am confident today’s seniors are capable of understanding an insurance benefit.

The AARP-endorsed Medicare prescription drug benefit is a groundbreaking achievement and sets the stage for future improvements in benefits and delivery systems for future generations of Medicare recipients.

The open enrollment period will conclude May 15. The program itself is voluntary, and no one is required to sign-up. Many seniors find that they already have existing credible prescription drug coverage either through a retirement plan, a former employer or the Veterans Administration. But if the option to sign-up for prescription drug coverage is not exercised, and then one wishes to purchase this in the future, there will be a penalty assessed. That is why is crucial that every one who has Medicare today, and has no prescription drug coverage, evaluate the program for themselves and make a decision as to what the best course of action would be.

I encourage people to look at the Medicare prescription drug plans on the basis of cost, coverage and convenience. If cost is the most important driver, simply look at the plans in tabular form which more clearly shows the three least expensive plans available within a given area. If someone is generally healthy and has few or no prescription requirements, the purchase of the lowest cost plan may be judicious in that it will provide insurability for the future should one's health status change.

For a senior who is already taking three or more medications, it will likely make sense to look at the coverage provided by different plans. This information is readily available at the Medicare website www.Medicare.gov or through the help line at 1-800-Medicare. The Internet can provide general information as to which drugs are covered under a particular plan.

And finally, there's the consideration of convenience. Does one wish to receive their medications via mail-order? Or perhaps the preference would be for a chain drug store or community pharmacy. All these options are available, but you should check and make sure the plan you are considering offers the option you prefer.

Is it hard? The answer may well be yes, after all it is health care, and health care related topics in the 21st-century are complex. Is it insurmountable? Certainly not, and by the middle of April, 1,887,826 Texans were enrolled in the program over 30 million seniors already receiving the benefits of the prescription drug program.

Throughout the development of this program there has been significant agitation for a one-size-fits-all typical government program with ever-expanding cost. What has been achieved thus far in the Medicare prescription drug program is a benefit that is available to millions of seniors with costs significantly less than were originally estimated.

There are real savings available for millions of seniors in the Medicare prescription drug program, but do remember it is constructed to more closely resemble an insurance product as opposed to an entitlement. It has proven to be popular and seniors are often surprised by the significant savings they receive when they purchase their medications.

I encourage anyone who is on Medicare, and who has not investigated this program, to spend a little time with it prior to the enrollment deadline on May 15th -- the money you save may be your own.

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