Editor's note: Medicare's prescription drug coverage commences next month and many seniors are still combing through fine print to determine how the new benefit will affect them. The Star-Bulletin received the following letter with questions concerning drug coverage for retired military personnel covered by Kaiser Permanente. A Kaiser representative provides an answer below.
Kaiser plan forces choice between bad or worse
MY WIFE AND I have been members of the Kaiser Senior Advantage Health Plan for 20 years. During this time the premiums have increased steadily, as have premiums for other health plans. We have been generally well satisfied with the service and agree with the publicity about their plan being the best overall HMO plan. We believe that the medical staff is competent and professional.
The nurse and nurses' assistants are likewise well trained and professional. I assume the administrators and financial personnel also are competent, as my monthly premiums are deducted from my bank account without fail.
However, I have just discovered a new policy, which might very well drive us out of the program. It involves the new Medicare Part D benefit, concerning drug coverage.
As a retired military service member, I have always enjoyed the privilege of obtaining most of our prescription drugs free from the military. I will always be able to do this, barring major changes in laws, and therefore have no need to enroll in Part D.
But Kaiser's new plan requires all Senior Advantage members to enroll in the Medicare Part D plan and have the Part D premium added to their regular monthly premium -- or to drop out of the senior plan altogether. In my case, it will mean that I will be paying a premium for something for which I have no need, as I will still obtain medicine from the military.
A few weeks ago, I attended an informational meeting held by Sage PLUS (the health information arm of the Executive Office on Aging), at our retirement community concerning Medicare Part D. At that time, I asked if people like me would be required to enroll in Part D. The answer was no. Obviously, the person was not too knowledgeable about the subject, or there has been a subsequent change in plans.
I do not wish to be forced to return to military medical care, as I believe active duty military deserve priority, and as long as I could afford to pay the premiums of an HMO I have done so. It is unfair for Kaiser to charge me for a service I do not need.
I would like it if someone from Kaiser would respond to this and tell me that I am completely off base, that my information is incorrect and that I may continue my membership in the Senior Advantage program without additional cost.
William G. Burlingame Sr.
Many gain from drug plan
WE AT Kaiser Permanente Hawaii appreciate William Burlingame sharing his views regarding our new Medicare prescription drug plan.
However, as a retiree of the U.S. military and a beneficiary of health plans from that service, Mr. Burlingame's situation is unique. It is important to stress to the thousands of others in the state who will soon have drug coverage through Part D that the views Mr. Burlingame shares apply only to individuals with his special circumstances. It does not apply to the majority of Kaiser Permanente Senior Advantage individual plan members.
With the introduction of the new Medicare Part D prescription drug plan, the Centers for Medicare & Medicaid Services required every health plan and prescription drug plan nationwide offering Medicare Part D to receive approval for the health insurance packages it would be offering.
Our approved plan requires that the coverage must be offered as a package to Medicare beneficiaries who do not have their Senior Advantage coverage through an employer, union or other group.
The approved package of benefits provides our members more than a drug plan. They are benefiting from the power of an integrated delivery system where the physicians and their care team have total care oversight.
Given Mr. Burlingame's situation, his Kaiser Permanente plan in 2006 will include both medical and drug coverage. We are unable to separate these components. If he chooses to remain a Senior Advantage member, he will pay for the drug portion of Senior Advantage. We hope he chooses to remain with Kaiser Permanente, but we do understand his concerns.
The Part D prescription drug plan is a welcome addition to Medicare for many, but it can be confusing. Kaiser Permanente has worked to educate our Senior Advantage members in multiple ways during the last few months, including letters, fliers at our pharmacies and newspaper advertisements.
We also have increased the number of customer service representatives to take calls from members. Kaiser Permanente members may call 432-5955 (Oahu) or 1(800) 966-5955 (neighbor islands) 8 a.m. to 5 p.m. Monday through Friday, and 8 a.m. to noon Saturday. Deaf or hard-of-hearing people who use a TTY may call 1-877-447-5990.
Sage PLUS will provide in-person advice or answer your questions over the phone. Please call 586-7299 on Oahu or (888)-875-9229 from the neighbor islands.
Medicare is also available to answer questions on the new plan 24-hours, 7-days a week at 1(800) Medicare. Information is available at www.medicare.com.
Vice president of business development
Kaiser Permanente Hawaii