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It's round 2 for Part D The Medicare prescription drug plan wins some converts in its first year

Lorraine Sullivan is a Medicare Part D veteran.

She and her husband, Joseph, struggled with the confusing barrage of information that accompanied the federal government's new prescription drug program when it started last January.

Back then, the Buffalo couple anxiously wondered whether Part D really would help with their mounting medication expenses.

Today, as the Dec. 31 deadline for the second enrollment year approaches, the Sullivans sound like satisfied customers and are encouraging others to enroll in a plan.

"It's been great for us," said Lorraine Sullivan. "We finally have some confidence that we can afford our prescriptions."

An estimated 38.2 million Medicare beneficiaries had some source of drug coverage by the end of the 2006 enrollment period, including 22.5 million enrolled in the new Part D plans, according a recent study by the Kaiser Family Foundation.

Most Part D enrollees joined stand-alone plans that accompany their traditional Medicare medical coverage.

But the Sullivans are among the 14 percent of beneficiaries in the nation who enrolled in a managed care Medicare program with Part D coverage -- in their case, Independent Health's Encompass 65 program.

The Sullivans also back-stopped Part D by enrolling in EPIC, the state's Elderly Pharmaceutical Insurance Coverage. With the two coverages, EPIC may pay for what Part D doesn't cover.

Also, New Yorkers who have EPIC and do not sign up for a Medicare private drug plan will not be penalized should they decide to enroll in a plan at a later date.

Echoing the advice of experts, Sullivan suggested seniors explore their eligibility for EPIC.

"We've gone from worrying about drug costs to complete coverage," she said.

Sullivan, 79, takes 11 prescription drugs for a handful of ailments, including high-blood pressure and narrowing of the arteries.

She is the major medication-user in the household and estimates that the couple's medication expenses have decreased by about two-thirds with the new coverage and EPIC.

"It was tough before. We live on our Social Security checks only," she said. "Drug costs can really crimp your lifestyle."

Surveys indicate that most seniors are satisfied with their Medicare Part D coverage, although problems still exist with the program.

For instance, a gap opens in coverage when an individual's drug costs reach $2,250 and then closes when out-of-pocket expenses reach $3,600. This is sometimes referred to as the "doughnut hole" in the coverage.

In addition, there are more Part D plans this year, including 61 stand-alone plans and 25 managed-care plans in New York State. And, many of the plans that carried over from last year have changed certain features, such as premiums, drug tiers, and brand name coverage in the gap.

In other words, don't assume that a brand-name drug that was covered this year will be covered in 2007. Check it out.

"The key point that people need to keep in mind is that no one is free from having to figure out what plan will work for them next year," said Deane Beebe, director of communications for the Medicare Rights Center, a consumer group.

Insurers were required to notify seniors of changes, although it's not clear the information is consistently getting through.

"Some companies sent out notifications. Others didn't. Still others mailed notifications that were difficult to decipher," said Beebe.

Despite the gaps and potential problems, the new coverage has helped many seniors.

The numbers of plans and complexity of the information can seem daunting, and Sullivan said it helped her to research options with a health insurer or other expert.

For instance, the Erie County Department of Senior Services, at 858-7548, offers health insurance information counseling.

"People told us the new plans can help," Sullivan. "That's the message I'd offer others."

e-mail: hdavis@buffnews.com

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