Best Prescription Drug Programs for Seniors

Drug cost are growing ever steeper, and baby boomers and their parents still are not used to a world where a single pill can cost over a hundred dollars and a one-month prescription can run into thousands of dollars. Many seniors are on lifelong prescriptions that cost more than their monthly income.

Most seniors over the age of 65 are eligible for Medicare. Medicare A covers the cost of hospitalization. Medicare B, available for a monthly premium, covers the cost of doctor's visits and durable medical equipment such as wheelchairs and hospital beds. Medicare D partially covers the cost of medications.

There are several different Medicare D plans to choose from. Each plan has a different formulary (list of medications they will pay for), a different list of preferred providers (pharmacies you can go to), and different monthly premiums, deductibles, co-pays, etc.

People who become eligible for Medicare usually have a short period or window, during which they can sign up for Medicare D. If they miss that window, they may have to wait several months for another opportunity, and they also may have to pay penalties associated with waiting to sign up.

Medicare D has been widely criticized as being too complex and confusing. Many seniors don't receive the coverage to which they are entitled because they miss their "window," or because they don't believe they need the coverage.

Those becoming eligible for Medicare D can get help working through the system in many ways. Many senior centers have programs set up to help clients select the best Medicare D plan for them. Many pharmacies are also offering to analyze the senior's medication list and help them pick the program that covers the greatest number of their medications.

Medicare D may be cumbersome to work through, but its benefits are real and can save seniors a lot of money on the high cost of prescription medications.

Some seniors, however, may not qualify for Medicare. In the United States, people are typically considered seniors when they reach 55 to 60 years of age, however the current age for full retirement is 65. For people born after 1960, the age of full retirement will be 67.

This means that people in their late fifties and early sixties must generally continue working in order to participate in their employer's health plan. For healthy seniors, this is not a problem, but some seniors begin to lose their health early due to conditions such as heart disease, diabetes, early onset dementia, etc.

People who can no longer work due to disability are often able to retire and have to pay out of pocket for the insurance the company was providing to them. (This program that allows people to continue their insurance even after leaving a job is called COBRA). In most circumstances, people can choose to pay out of pocket for their insurance for eighteen months after leaving the employer. This may be long enough to qualify for Medicare. For instance, say a man born before 1938 who had just turned 64 had a stroke and could not continue working. He could pay an out of pocket premium to his employer's health program for a year, until he turned 65. He would then be covered by Medicare and could select a Medicare D program to help with the cost of his prescriptions.

On the other hand, suppose this man was younger, in his fifties, when he had his stroke? His best bet would be to keep his insurance through his employer as long as possible and immediately apply for disability through Social Security. Twenty-four months after being declared disabled by social security, he would become eligible for Medicare.

Unfortunately, this still leaves a six month window during which the man would not be covered by any insurance. During this time, he might have a few choices. If his spouse is employed, perhaps he could pick up health coverage from her employer until he qualified for Medicare. If he had sufficient income, he might have to pay for prescriptions out of pocket.

If paying out of pocket is not a possibility, and for most seniors it isn't, he might check into an assistance program such as Partnership for Prescription Assistance (www.pparx.org). Partnership for Prescription Assistance analyzes the medications being taken and helps seniors and their doctors find assistance programs, often through the pharmaceutical companies that manufacture the drugs.

Finally, a person in extreme financial difficulty might be eligible for Medicaid. Medicaid provides medical assistance to indigent (extremely poor) citizens. Different states have different qualification guidelines. More information about Medicaid programs is available at http://www.cms.hhs.gov/home/medicaid.asp.

Drug costs can be very expensive, but with a little bit of information and assistance, most seniors can find the help they need with their prescriptions.