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Why you must look at your Part "D" Plan Today
Your work on part "D" is not over yet!
You have until March 31 to act.
Surviving With Medicare Part "D"
February 1, 2008 - - Robert Fassbach, editor,
www.seniorark.com
So now it's February, and you think your worries about
Part "D" are over. Not so fast. What you do right now
can determine how well you do for the rest of the year
in getting the medical care and prescriptions you need.
I turned 65 the day before Christmas, about 5 weeks ago,
so this is my second month living under Part "D". Getting
here has been an experience. I have been studying and
writing about the nuances of Part "D" for over two years
on SeniorArk, and in various other publications. But
until I entered the scene myself, I had no idea of the
extreme confusion surrounding the process. Even now,
having made an "informed" decision for 2008, I am not
completely sure I have made the best choice for my
needs. I have a plan that will work, but Pennsylvania
has some 150+ plan possibilities out there, all being
offered by private insurance companies interested more
in my money than my health. During insurance company
plan presentations I heard misrepresentation,
half-truths, and outright misinformation. But a choice
was needed, so one was made.
Years ago, when I managed a real estate office in
suburban Washington D.C., my boss, Bill Ellis, told me,
"I just sold my Bethesda home after several years, and
have moved to another one in Potomac. I had no idea what
our buyers and sellers go through every time they move.
I think every manager in our company ought to be
required to move every 5 years just to keep the memory
fresh." He was right. And I just found that out
when I turned 65. Now I get it. What we are put through
as we decide on Medicare and Part "D" is a serious
trauma.
So then, if our decisions on Part "D" were made between
November 15 and December 31, what is there to do between
now and March 31? Well, here goes.
(1) If you have "traditional
Medicare", and a "stand-alone" Part "D" plan, get
out all those papers from your Part "D" insurance
carrier and really read them. Get on- line, or on the
phone and make sure you have a plan that will cover the
drugs you anticipate needing. Review the co-pays and
other details of the plan. Ask questions of your insurer
if there is ANYTHING you don't understand. You are the
customer. They want your business. They must be clear.
And don't assume that everything is the same as last
year if you have continued the same policy. Insurance
carriers are subtly eliminating everything
possible within the law, and are not standing on the
rooftops shouting out the news. You must dig for it.
(2) Now let's assume that you have reviewed
the details again, and have decided that you
are
in the right plan. Then today we 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, in the "stand-alone" Part "D" plans, you are
paying the first $275 of annual drug costs, and then 25%
of the next $2,235 ($558.75). After that, you will pay
100% of the next $3216.25. 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. The average stand-alone
premium is somewhere around $40 per month. Some with
higher premiums may be more generous.
(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) Go online, or call your state's agency on
aging, or the equivalent department, to determine if you
may actually qualify for additional 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 Part "D"
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
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. At
Medicare's website, you'll
find a
plan finder that will help you
choose a plan based on a number of factors, such as what
drugs are covered, how much you can afford to pay, and
what pharmacies participate.
Another tool lets you enter
the drugs you need and then shows you what plans cover
them.
Here are the different coverage scenarios permitted
during Medicare Advantage open enrollment:
-
If a person on Medicare currently has coverage in a
Medicare Advantage Plan with prescription drug
coverage, they can use open enrollment to select a
different Medicare Advantage Plan with prescription
drug coverage, Original Medicare and a stand-alone
prescription drug plan, or a Medicare Advantage
Private-Fee-For-Service Plan and a stand-alone
prescription drug plan.
-
If a person on Medicare currently has coverage in a
Medicare Advantage Plan with no prescription drug
coverage, they can use open enrollment to select a
Medicare Advantage Plan or Original Medicare without
prescription drug coverage.
-
If a person on Medicare currently has coverage in
Original Medicare with a stand-alone prescription drug
plan, they can use open enrollment to select a
Medicare Advantage Plan with prescription drug
coverage or a Medicare Advantage
Private-Fee-For-Service Plan with the same stand-alone
prescription drug plan.
-
If a person on Medicare currently has coverage in
Original Medicare without a stand-alone prescription
drug plan, they can use open enrollment to select a
Medicare Advantage Plan without prescription drug
coverage.
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 contact
Medicare 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 Part "D"? I opted for a Medicare
Advantage plan through Health America Advantra. Monthly
premiums $42. No initial deductible. Most of my doctors
are in the program, as is my hospital. With minimal
co-pays they include some generic drugs through
the doughnut hole. I have already had blood work done
this month, and find that they require me to go to a lab
that I consider third rate in its appearance and speed.
Not the hospital lab I was accustomed to seeing. Am I
recommending Advantra? Not a chance. You must make your
decision, with your needs, in your state. I'll let you
know how it goes for me this 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. What may happen after this
coming November MAY be another story. Until then, 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
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