September 24, 2005|By M. William Salganik | M. William Salganik,Sun reporter
Despite early fears that the new benefit might prompt the loss of retiree benefits, McClellan said, most employer and union retiree prescription plans won't be changing; the federal government will subsidize those retiree plans as long as the coverage is at least as good as the new Medicare benefit.
Seniors can also get prescription coverage as part of Medicare Advantage plans -- full managed-care health insurance. Medicare Advantage plans have been around for years under a variety of names, but are expanding as the new Medicare law increased their reimbursements.
FOR THE RECORD - An information box accompanying an article in Saturday's editions of The Sun on the new Medicare prescription drug plan misstated the gap - or "doughnut hole" - in coverage. The gap - the amount of expenses for which there is no coverage - is from $2,250 to $5,100. The plan pays 95 percent of expenses above $5,100. The Sun regrets the errors.
Those plans limit the choice of doctors and hospitals, but as a trade-off can offer additional benefits. For example, David Weinstein, president of Elder Health Mid-Atlantic Inc., a Baltimore-based Medicare HMO, said his plan offers transportation to medical appointments as a benefit option.
Some Medicare Advantage plans, including Aetna and Elder Health in Maryland, offer a no-premium option, but also offer more benefits for additional monthly costs.
Marsha Gold, a senior fellow at Mathematica Policy Research who studies Medicaid managed care plans, said that Maryland had a number of such plans in the 1990s, but many shut down when Medicare lowered many reimbursement levels, and that may make consumers wary.
"In Baltimore and Maryland, where there have been drop-outs [by plans], people will be skittish," she said. "But these plans will be attractive to people worried about out-of-pocket costs."
bill.salganik@baltsun.com
Insurance information
Terms of coverage
Below are the terms of coverage under the basic private Medicare drug insurance plan. Various plans will offer other options, at various premiums, such as no deductible or coverage of the so-called doughnut hole.
Patient pays first $250 of prescription costs; insurer pays 75 percent coverage between $250 and $2,250.
No coverage for costs between $2,250 and $3,600, the so-called "doughnut hole."
Insurer pays 95 percent of costs above $3,600.
Medicare prescription plans
Insurers offering free-standing Medicare drug plans in Maryland - pharmacy coverage separate from any other health insurance.
Aetna Life Insurance Co.
American Progressive/Marquette National/Pennsylvania Life
Connecticut General Life
Coventry/First Health
Elder Health Maryland HMO
First Care Inc. (CareFirst)
Humana
Medco Containment Life
Member Health
PacifiCare Life & Health
QCC Insurance d.b.a. AmeriHealth
RxAmerica
Silverscript
Sterling Life
Unicare
United American
United Healthcare
Wellcare Health Plans
Medicare Advantage Plans
These are the Medicare Advantage plans available in Maryland. All offer coverage for their network of physicians and hospitals, plus prescription benefits.
Aetna US Health Care PPO
Aetna US Health Care HMO
Elder Health Maryland HMO Inc.
United Healthcare
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