If I need information on choosing a plan for Medicare Part D does anyone have any good advice or information about chosing plans. I’ve found some good information on aarp.org and medicare.gov.
Any have more suggestions?
Thanks and happy new year!!
a) You get financially penalized if you do not choose any plan (assuming that at some later point you do opt in; AFAIK there are no penalties if you choose to forego Medicare D coverage permanently) —e.g., if you don’t sign up this year or next but decide in '08 to sign up, you pay the '08 premium rate times some percentage times 2 years of nonparticipation. So if you don’t see any plans that you like, you may want to consider buying into the cheapest plan available. (Some only cost ~$5/month.)
b) In my opinion (which is largely shaped by my better-informed girlfriend who is on Medicare and very pissed), the thing is a mess, as I will describe below. This may mean it gets fixed. It could definitely become quite the political football in '06. Stay tuned for details. You may want to participate in the shouting.
c) You have to pick a plan; each plan only covers some meds, any you need that aren’t covered by your plan, you pay for out of pocket and what you spend on them does not count towards deductibles or anything else Med D pays attention to. So do research on the plans available to you and which meds they cover. I realize you have no crystal ball to tell you what new meds your doctor might put you on later this year, but you have to do the best you can. Cost-compare with how cheaply you can get meds from out-of–pocket sources — there are many cut-rate internet sites based right here in America that you can legally and authentically use to fill your local doctors’ Rx, generally for 3 month supply. My girlfriend uses drugstore.com, for example. So let’s say you are on Expensive Med #1 and Midpriced Med #2 and Cheap Med #3… Plan X covers Expensive Med #1 and Cheap Med #3 and you can get generics of Midpriced Med #2 from drugstore.com or similar place for a reasonable price. That could make Plan X better than Plan Y which covers Midpriced Med #2 and Cheap Med #3 but not Expensive Med #1.
d) The plans can do a bait-and-switch on you, changing what they will cover after folks have signed up for them, with just a month’s notice. Notice only goes out to current participatns, and you can’t change plans until next year so you’re stuck with them if they do this to you. At least get current info, since what the medicare site shows re: coverage isn’t necessarily up-to-date.
e) Plans may be available to you but no pharmacies in your area enrolled in them. Obviously, an otherwise good plan that requires you to drive halfway across the state to fill your meds isn’t so good after all. The catch is that pharmacies can stop participating in plans pretty much at will, but again, at least get current info.
f) Coverage isn’t like most folks’ conventional medication insurance coverage, where a med is either covered or it ain’t, you do or don’t pay a deductible before plan coverage kicks in, and there’s a co-payment of some size (perhaps different for different tiers of drugs). Instead, there’s a deductible; then Medicare D starts paying a percent of your med cost but only up to a certain line. When your covered Rx-drug expenditures for the year reach that line, Medicare D stops paying for your meds and you pay for them entirely out of pocket for the rest of the year, until/unless you reach another line. When your covered Rx-drug expenditures reach the second line, Medicare D picks up 100% of your covered meds cost from then on until the end of the year. My girlfriend says she will reach the first line around March of each year and never reach the second line unless she has a medical crisis and gets put on expensive meds (that conveniently happen to be covered), and that most other folks also won’t ever cross the second line. That’s not based on real-world experience yet, of course.
f) If you have “Medi-gap” coverage you’ve been using in addition to Medicare, expect that to disappear unless you’ve specifically heard otherwise from your Medi-gap insurance carrier. Most of them are switching to Medicare-D offerings in the expectation that everyone will be on that instead.
This is my job for the next month so if you have any specific questions I’ll be happy to try to answer them.
Eligible people have until May 15 of this year to sign up with no penalty. After May 15 the penalty is 1% per month cumulative. If the eligible person has creditable coverage (as good as or better than Medicare) and in the future lose that coverage they will not be penalized as long as they join with 63 days of losing the coverage.
Medicare will pick up 95% once the second line is reached; 5% is still patient responsibility.
The standards you’re describing are minimum standards that plans must offer to get Medicare approval. Plans are free to offer lower deductibles and copays/coinsurances and coverage in the “donut hole.” The medicare.gov website allows people to enter their drugs and dosages and do a cost comparison based on their current drug use and pharmacy preference. Oftentimes plans with higher premiums and estimated monthly costs are actually better values because of that donut hole coverage. People can also call 1 800 MEDICARE and, if you can wend your way through the voice prompts, you’ll get to talk to me or someone just like me only nicer, and we can do that for you.
There are also Medicare Advantage plans, which function like HMOs and help pay for non-drug medical costs that Medicare otherwise doesn’t cover. I don’t work with those and know nothing about them.
I’m not an enormous fan of Walgreen’s drug stores, but their pharmacies do have a computer program to compare all the plans available to a person in a given state/location according to a listing of the prescriptions the person has/needs. It produces are fairly understandable printout comparison.
Cool, that’s worth checking out!
That’s what I thought. I got one last month, but I’m having to have it redone because the pharmacist omitted one of the in-patent drugs I need. She said today that they’re swamped. It sounded like the program is on (a) mainframe(s) and is run there, with the only local stuff being the results printed out. So, potential users may need to make the request and come back in a day or so for the results. I don’t think I’d try calling instead of stopping by to ask for it if I weren’t already a customer of their pharmacy.
Y’know, other chains might just have a similar program available to their branch locations. It doesn’t hurt to ask.