THIS IS THE SENIORARK MEDICARE BIG RED NEWS BOX

(Your source for the latest Medicare information, as you make decisions for 2010)

For more helpful information on Medicare, Parts A, B, C, and D, the Donut Hole, the

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Why you must look at your Medicare Advantage Plan Today

You can still make changes between January 1 and March 31, 2010

Robert Fassbach, editor, www.seniorark.com  

(2) Now let's assume that you review the details of your Medicare Advantage plan and decide that you are in the right Medicare Advantage plan with prescription drug coverage. Or you are in traditional Medicare with a stand-alone part D drug plan. Then today you need to think about the doughnut hole. The best time to begin avoiding it is right now. This week I met with my doctor to go over the salad of drugs that seem necessary to keep me going each month. I told him I wanted to find a generic for every one of them. He was willing to do that with one exception, and I may still decide to change that one. It is a statin, and I'm not convinced that Lipitor is necessarily better than several others out there. I will need to do a little research on that. 

Here are some examples of the savings when switching from Brand to Generic:

• Celebrex 200mg, a medication used for arthritis, costs about $100 for a one-month supply. Replace with Meloxican 15 mg (generic for Mobic) costs about $8. Cost difference,$1100/yr.

• Lipitor 20mg, used for cholesterol, costs about $111 for a month's supply.  Simvastatin, (generic for Zocor) cost $11. Savings, $1200/yr.

• Prevacid 30mg, a medication for heartburn, costs about $144 for a one-month supply. Omeprazole 20mg (generic for Prilosec) costs about $27, or a savings of $1400/yr.

• Tricor 145mg, a medication for triglicerides, costs around $100/mo. Fenofibrate (generic for Tricor) costs $37, for a savings of about $750/yr.

Remember for 2010, in the "stand-alone" Part "D" plans, you are paying the first $310 of annual drug costs, and then 25% of the next $2,520 ($630). After that, you will pay 100% of the next $3,610. This is the doughnut hole. (see chart) How fast you reach this expenditure level is determined by what your pharmacy bills your insurance company, not what the insurance company pays your pharmacy. If you are using generics, it will take much longer to reach the doughnut hole than if you are using brand  name drugs.

(By the way, this is also a good time to go over your medications to determine if you still need every one of them. Over time, medications are prescribed that should be given for a limited time, but they are never stopped. Several doctors, including your specialists, may have written prescriptions that just keep refilling automatically long after their need ends. Doctors are so busy these days, that many overlook this. Make them look.)

(3-a)  Go online to see if you you qualify for Federal help with your Medicare expenses.

(3-b) Go online, ( click your state on the map at this page) or call your state's agency on aging, or the equivalent department, to determine if you may actually qualify for additional state prescription help. There is a lot of it out there. My state, Pennsylvania, has 2 tremendous plans for couples earning less than $31,500, and individuals below $23,500. You may be passing up help that is staring at you. See our "Surviving the Doughnut Hole" page for 14 ideas on dealing with the doughnut hole.

(4) Let's assume that you looked over your paperwork, and decide that you may have made a Medicare Advantage mistake. Now there are two choices: live with it until next year (changing to something else between November 15 and December 31, 2008), or switching NOW to a Another Medicare Advantage Plan, occasionally  called Medicare Health Plan, and also called Medicare "C". (see simple description)  Open enrollment has not ended for these plans. Open enrollment for Medicare Advantage plans goes until March 31.  This plan is not administered by the government, but is handled by private insurance companies. It combines Medicare A, B and D. There are a wide variety of plans, and types of Medicare Advantage Plans.   If you take a number of prescription drugs, however, it gets more difficult to choose. Certain plans might cover some of the drugs you need but not all of them. But there are a number of resources to help you choose. Medicare's Part D, or  Medicare Advantage Plan Finder enables you to enter your drugs, for your area, and determine which plan makes the most sense for you.

Be aware that if you switch to a Medicare Advantage Plan, you must review much more than just the Part "D" portion of the policy. That insurance carrier takes over your "full care", and provides the features of Parts A, B, and D. Study which doctors, hospitals, and other types of care are included with the policy. Medicare pays the Medicare Advantage insurance provider  around $650/month for every month you are in their care, whether you need them or not. 

We hope all of this adds to your options, and not to your confusion, If questions remain, you can always search at www.medicare.gov, or call 1-800-MEDICARE. There may also be a state representative available to give you some help.

So what was my choice with Medicare and/or Part "D" for 2010?

I opted for a very different Medicare Advantage plan this year. My premium for last year's policy went to $76/mo., and the benefits were severely reduced. This year I have gone to Highmark-Freedom Blue PPO. There are NO monthly premiums, but I do have a $1200 annual deductible on the larger expenses. My premiums alone would have been $912 under my old plan, and co-pays would have pushed it quickly over $1200 if I needed any hospital or lab related care. We'll see how this works. I am a government-created gambler; I gamble on what I will need during the next year. What a system. I have no deductible in the drug portion of the program, and will pay $7/mo for generics and more for brand names. There is no donut hole coverage, but I found that I did not reach the donut hole last year.

A final comment. I think it is obscene that our government puts us through this traumatic, risky, confusing process. I totally support a "single-payer" system, run by the highly competent Medicare section of the Department of Health and Human Services. They can administer the program more cheaply, and would have huge negotiating power with drug and other suppliers. The only thing standing in the way has been Congressional backbone, and Presidential consent. Insurance and drug lobbyists have wielded enough power to control these programs up to this point. Until it is changed, we must sift through this program as best we can. Best wishes.

You may also want to read: Medicare Advantage open season  and  I'm Falling into the Doughnut Hole

      For much more helpful information on Medicare, Parts A, B, C, and D, the Donut Hole, the CPI-W, Current Medicare News Articles, and much more, see our Medicare Page.