How to Pick a Plan
Lipitor. Nexium. Plavix. Fosamax. You know that slew of pills you take every day? They're going to help drive your choice of a Medicare drug plan
Medicare beneficiaries face one of their biggest decisions ever: whether to sign up for Medicare Part D and, if so, which plan to choose. While everyone's needs are unique, there are some general things each person should consider when beginning the search for a drug plan.
Cost, of course, is a primary factor. But monthly premiums don't tell the whole story, as price tags will vary by the amount of the annual deductible, the copay (a flat rate per prescription) or co-insurance (a percentage of the prescription price), and whether the plan covers the "doughnut hole," the portion of the standard Part D plan policyholders are required to pay. A senior with annual pharmaceutical bills of, say, $3,000, would fall into that hole and might want to consider paying a higher premium for a plan that helps shoulder those costs. Someone with drug costs of $10,000 or so might be better off with a plan that doesn't cover the hole. That way, he or she will reach the threshold for catastrophic coverage quicker.
A plan's formulary (list of covered drugs) is also key. "I take six or seven prescriptions on a daily basis," says Helen Schaefer, a 77-year-old living in Wilmette, Ill., who suffers from arthritis. Getting coverage is especially important for those who are taking an essential and expensive drug that isn't in one of the universally covered categories. "If you take five medications, you need, one way or another, to find a plan that will cover all five," says Amy Bernstein, coordinator of the Health Insurance Information, Counseling, and Assistance Program in New York City. "Then you've got bingo."
People who pop a lot of pills may not find one plan that fills the bill. In that case, a senior might want to enlist a doctor's help. "Have him or her review your drugs," says Marion Aspinall, statewide director of Serving Health Information Needs of Elders, a state program in Massachusetts. Can any of the drugs be switched, or is it crucial to have the name-brand pill? Are generics an option? In short, seniors should determine the flexibility of their medications and pinpoint which drugs should steer the plan decision. Jackie Kosecoff, executive vice president of PacifiCare, one of several nationwide insurers, says some of her company's plans will include such assistance.
So far, the best way to compare plans is via the government's Medicare Prescription Drug Plan Finder (www.medicare.gov) , a Web tool that provides prescription prices for various plans. It isn't perfect--it won't be complete until early this month--but other tools on the site, like one giving a quick rundown of local plans, offer a first step. "Before you start looking at very specific options, it's a good idea to look generally and see what coverage works for you," says Mark McClellan, administrator of the federal Centers for Medicare and Medicaid Services. By the start of the enrollment period, "beneficiaries will definitely have the information they need to make a confident choice," he says.
Another important factor: the ease of getting prescriptions. "Most people are very attached to their particular pharmacy," says Hilary Dalin, Medicare coordinator at the Health Assistance Partnership, a nonprofit in Washington, D.C. Those with limited access to drugstores might want to ask their favorite pharmacist which plans they're going to participate in, and whether they'll be part of the plan's preferred or nonpreferred network (preferred pharmacies offer lower prices). Snowbirds, who may spend half the year in warmer climes, should make sure the pharmacies there are also part of the chosen plan. Mail-order is also an option.
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