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A fresh look at Part D

Nov 5, 2013


By News-Register Contributor

I have been enrolled in the same Medicare prescription drug plan for three years now, but my pharmacist told me I should look for a new plan during the open enrollment period that would fit my needs a little better. What’s the easiest way to do this?

—Need Help

Because all Medicare prescription drug plans can change their coverage and costs each calendar year, the only way to ensure you’re getting the best coverage at the lowest cost is to compare your Part D plan against the competition during Medicare’s open enrollment period (which is Oct. 15 to Dec. 7). Here are some tips and resources that can help you compare drug plans, and select one that better fits your needs.

Important: Don’t confuse Medicare open enrollment with the new health insurance marketplaces that have just opened under the Affordable Care Act (aka Obamacare). They serve two totally different populations. Health insurance marketplaces are for people under age 65 who don’t have health insurance, while Medicare open enrollment is for Medicare beneficiaries who wish to review their current Medicare policies and make changes.

 

OPEN ENROLLMENT WEBSITE

If you’re comfortable using a computer, you can easily compare Medicare’s drug plans yourself online. Just go to Medicare’s Plan Finder Tool at www.medicare.gov/find-a-plan, and type in your zip code or your personal information, enter in how you currently receive your Medicare coverage, select the drugs you take and their dosages, and choose the pharmacies you use. You’ll get a cost comparison breakdown for every plan available in your area so you can compare it to your current plan.

This tool also provides a five-star rating system that evaluates each plan based on past customer service records, and suggests generics or older brand name drugs that can reduce your costs.

It’s also important to keep in mind that when you’re comparing drug plans don’t judge a plan strictly by its monthly premium cost. Low-premium plans are often associated with higher prescription co-payments and may end up being more expensive. Look at the “estimated annual drug costs” that shows how much you can expect to pay over a year in total out-of-pocket costs — including premiums, deductibles and co-pays.

Also, be sure the plan you’re considering covers all of the drugs you take with no restrictions. Some plans may require you to get permission or try a number of cheaper drugs before they will cover certain prescriptions.

 

NEED HELP?

If you need some help with this or if you don’t have Internet access to compare the plans yourself, you can call Medicare at 1-800-633-4227 and a customer service representative will do it for you over the phone for free.

Another resource that you can call on for help is your State Health Insurance Assistance Program (SHIP), which provides free one-on-one Medicare counseling in person or over the phone. They also conduct seminars during the open enrollment period at various locations throughout each state. To find the contact information for your local SHIP visit www.shiptalk.org, or call the eldercare locator at 1-800-677-1116.

 

SHRINKING DONUT HOLE

You also need to know that Medicare’s “donut-hole” — the coverage gap in which you must pay out-of-pocket for your drugs — continues to shrink. In 2013 and 2014, you will get a 52.5 percent discount on brand-name drugs, and the federal subsidy for generic medications will rise from 21 to 28 percent in 2014.

The 2013 coverage gap begins when your total drug cost exceeds $2,850 (that includes your share and the insurer’s share of the costs) and ends when combined spending is $6,455. After that, your Part D plan usually covers around 95 percent of your remaining drug costs for the year.

Send questions to Jim Miller at Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit www.savvysenior.org.

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