Covering the Bases: Change plans to utilize benefit

Q: I am eligible for the Extra Help program to help pay for my prescription drugs because my income is very limited and I have no savings at all. I am enrolled in a Medicare Part D plan that I chose with the help of the Senior Health Insurance Program two years ago.

I got a letter last month that seems to tell me that I still qualify for Extra Help, but that my co-payment level is going up in 2009. Can I do anything to avoid that increase? I can't really afford it.

A: You are referring to a letter that was sent to you on light orange paper in early October. The company that provides your prescription drugs through Medicare Part D is not offering a plan that keeps your premium under the Extra Help level or that reduces your co-payments to the level you are used to paying.

You will need to research the plans available using your prescription drug list to find a plan that better suits your needs. SHIP can assist you. You can call for an appointment, or ask for a form to be mailed to you which will allow you to provide your prescription drug information to a SHIP counselor, who will do the research for you in the Medicare database and mail the results to you.

If you don't choose another plan, you will still have coverage, and you will have the option of choosing another plan at any time during 2009. However, it's a good idea to find a plan that uses your Extra Help benefit to your best advantage.

A: You are correct that the government has specified that some drugs generally may not be covered by a Medicare Part D plan. They include drugs prescribed for weight loss or weight gain; drugs for the symptomatic relief of coughs and colds; prescription vitamins, except for prenatal vitamins and fluoride; over-the-counter drugs; drugs to promote hair growth; fertility drugs; cosmetic drugs; some anti-psychotic medication that must be monitored by testing services offered only by the manufacturer of the drug; barbituates; benzodiazepines; and drugs used for erectile dysfunction if prescribed for the treatment of sexual dysfunction.

Some Medicare drug plans may opt to cover non-Part D drugs as an extra benefit. You would need to check with the individual plans to see if they offer this extra benefit.

A: Since you have not applied for your Social Security benefit, you will not be enrolled in Medicare automatically, and you don't need to contact the Social Security Administration. When you decide to retire and apply for your Social Security benefit, you can apply for Medicare at that time, too.

Susan Knight is a senior health insurance consultant. If you have questions about the information in this column, contact the county's Senior Health Insurance Program at the Department of Aging and Disabilities at 410-222-4464 or ship_program@aacounty.org.