Under Part D, a municipality could choose between alternative approaches in providing prescription drug coverage for its Medicare retirees. It could decide to maintain its own coverage and apply for the federal Retiree Drug Subsidy or, instead, enroll them directly into a Part D plan.

"We've been concerned that a town would choose the second option and select an inferior Part D plan - saving itself a great deal of money while our members end up paying substantially more," states Insurance Coordinator Cheryl Stillman. "According to our Greenfield members, that's what happened there."

In 2004, Greenfield adopted section 18 of the municipal health insurance law (Chapter 32B) or, as we call it, mandatory Medicare. While Section 18 allows a municipality to force its Medicare-eligible retirees into that federal insurance program, the law does impose certain obligations, including that the insurance coverage for those under Medicare be equivalent to that for the non-Medicare retirees.

Beginning this year, Greenfield automatically enrolled its Medicare-eligible retirees, numbering about 320, into a basic Part D plan with a supplement ("Sterling Retiree Rx"), which is underwritten by Sterling Life Insurance Company and administered by IdealScripts. Retirees, who are not eligible for the federal program and total some 80 in number, continued their coverage under the non-Medicare plans offered to employees and their families.

A retiree, enrolled in Sterling Retiree Rx, pays for the first $250 of prescriptions, then 25% of their drugs costs from $251 up to $13,650 and finally 5% for prescriptions over $13,650. This is commonly referred to as co-insurance, in contrast to the generally recognized approach by which retirees purchase their prescriptions by making copayments.

With its supplement, Greenfield's plan picks up 75% of the cost over $2,251 (up to $13,650) and addresses the so-called "doughnut hole" contained within the federal law creating Part D. Editor' Note: A major criticism of Part D is the "doughnut hole" or gap in drug coverage, which calls for a retiree to pay 100% of their prescriptions over $2,250 until they've spent a total of $3,600, at which point they will start to pay 5%.

In notifying its retirees about Sterling Retiree Rx, Greenfield states that the new plan "should reduce your out-of-pocket spending for prescription drugs." But, initial reports from our Greenfield members contradict this claim.

"Our members are paying much more out of their pockets for prescriptions than they were a year ago," reports Stillman. "Some have figured out they could end up paying thousands more for their prescriptions and naturally they're extremely upset."

"Last year at this time, I was enrolled in Medex and could pay my prescription bills," according to June-Anne Aumond, a retired teacher. "Now with this new plan, I've estimated it could cost me four times as much. "

"We've contacted Greenfield officials and expressed our strong concerns over this plan," stated Stillman. "Whether Greenfield is satisfying its legal obligation to provide these retirees with coverage, equal to that offered to non-Medicare retirees, and, therefore, violating state law (section 18)."

"Greenfield has done right by its retirees on other aspects of their health insurance, for example, the 75% refund on the Medicare Part B premium. With that in mind, we are hopeful that something could be done to improve the drug coverage for these retirees." At press time, the Association is awaiting a response by Greenfield officials.