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Public Employee Press
Retirees may switch drug
and health plans in November Union
plan plugs the Medicare donut hole Many retirees are being inundated
with information about Medicare Part D plans because November is the open enrollment
period for the one-year-old government-funded drug benefit. This November
is also a reopener period when retirees are allowed to switch their
city health care plan. Last year, when the federal government launched
the Medicare Part D drug benefit, thousands of DC 37 retirees opted for plans
offered by insurance companies or were automatically covered for medications by
their Medicare Advantage plan, such as HIP VIP. Deciding to tap into
the massive federal funding for the new benefit, many Medicare Advantage plans
added prescription drugs to their overall coverage. That made employer or union
plans, like DC 37s prescription benefit, secondary for retirees in Medicare
Advantage health plans. Retirees who are happy with their current plans
should probably sit tight. The DC 37 Health and Security Plan urges anyone
contemplating a change to call its Health Insurance and Pension Unit at 212-815-1200.
Generally, the DC 37 benefit offers a better deal, with lower co-pays, more
comprehensive coverage (see accompanying box), and no deductible, while Part D
has a $265 deductible for 2007. And Medicare Part D has the infamous
donut hole, the annual gap in coverage where participants must pay
100 percent of the cost of their prescriptions. In 2007, the gap affects expenditures
from $2,400 to $5,451. When retirees in Medicare D hit the gap or their
plans annual maximum, the DC 37 prescription drug benefit will cover them,
but only if they contact the union. Last year, DC 37 worked with HIP to ensure
that retirees affected by the annual maximum were automatically enrolled in the
union benefit. But union officials fear many retirees in other Medicare Advantage
or independent plans may go without gap coverage if they are unaware that they
must contact DC 37 to be reinstated in the union benefit plan. Changes
in enrollment in the citys health plans and Medicare Part D plans are effective
Jan. 1, 2007. Information about the health plans offered by the city is available
at Health Benefits Program on the Web page of the Office of Labor
Relations, which can be accessed by going to www.nyc.gov
and clicking Labor Relations in the list of agencies. Retirees
may also find out about the citys health plans by visiting or calling the
Health Benefits Program, which is on the third floor at 40 Rector St. in Manhattan.
The phone number is 212- 513-0470.
Gregory N. Heires
Prescription drug plan comparison |
| DC
37 Health and Security Plan | Medicare
Part D (2007) | Retiree | Spouse |
Whos
covered? | Member,
spouse and eligible dependents | Medicare
eligible retiree only | Medicare
eligible spouse only | Monthly
premium | $0 | $30
to $35 | $30
to $50 | Annual
deductible | $0 | $265
for retiree | $265
for spouse | Prescription
drug costs between $1 and $265 | $
5 generics $15 preferred $35 non-preferred | No
coverage. Retiree pays full cost until $265 deductible is met. | No
coverage. Spouse pays full cost until $265 deductible is met. |
Prescription
drug costs between $265 and $2,400 | Same
co-pays as above | Retiree
pays 25% of cost, Medicare pays 75% | Spouse
pays 25% of cost, Medicare pays 75% |
Prescription
drug costs between $2,400 and $5,451 | Same
co-pays as above | No
coverage (gap) | No
coverage (gap) | Prescription
drug costs over $5,451 | Same
co-pays as above up to $100,000 annual limit | Retiree
pays 5% of cost, Medicare pays 95% | Spouse
pays 5% of cost, Medicare pays 95% | | |