The Medicare Conundrum

Choosing a Medicare prescripton drug plan can be a daunting task since there are many variables to take into consideration, such as the cost of the plan in terms of premiums, copays and deductibles, the availablility of plans offering coverage in the area where you live, and whether or not all your medications are covered. The “Medicare and You” handbook, mailed out in October every year to Medicare recipients contains information on any new coverage or changes in the laws, the various types of Medicare coverage (original Medicare, Medicare Advantage and Medigap), and the insurance plans offering coverage for Medicare prescription drugs available for the region in which you live. The process of selecting the “right plan” has become a yearly research project for many people when some insurance plans pull out of coverage areas, raise rates or drop medications from their lists of covered prescriptions.

Although Original Medicare allows patients to see any doctor and use any medical facility regardless of where they live, it does not offer coverage for prescriptions. Under the Medicare Part D law, there are Medicare approved stand alone insurance plans that offer coverage just for prescription medications. Each plan usually charges a standard annual deductible and monthly premiums that vary by insurance company.  Private insurance companies also offer Medicare Advantage plans that not only cover prescription drugs, but also provide coverage for dental and vision care, and extra coverage for doctor and hospital visits.. These plans may or may not charge a monthly premium and yearly deductibles, but the patient must use doctors, hospitals and labs within the plan’s network or pay higher copays by going out of network.

One of the most important things to consider when choosing a presciption drug program through Medicare is affordability. Each patient must be sure he or she will be able to pay the monthly premiums and any yearly deductible, along with the copay for each medication needed. The Medicare and You handbook lists the monthly premiums and deductibles for each plan available in your area. You can also find the same information on the Medicare website if you prefer online research. Once you have selected several plans within your price range for premiums and deductibles, you will need to search the formularies for those plans to see if your medication(s) are covered. The formularies, or lists of all medications covered, will also provide information on whether or not your medication is considered generic, preferred brand name, non-preferred brand name, or specialty drugs, the monthly copay for each of your medications, and the type of pharmacy (local or mail order) that iscovered.  When comparing plans, you will also be able to determine if any plans offer any coverage once you have hit the coverage gap or donut hole. Most of the plans will also provide information on the approximate month you will reach the coverage gap and what costs you will incur on a monthly basis until you reach the catastrophic level.

Because of the changes in coverage area and costs every year,  Medicare recipients need to reassess their plans and requirements. This process may be more difficult for recipients who don’t have access to a computer to do the research and comparisons. It may be confusing for elderly citizens who may not understand all the benefits they need to consider before making a selection. You can receive assistance from a Medicare representative by calling 1-800-633-4227, or 1-877-486-2048 for the hearing impaired. Your local Department of Aging office offers assistance by phone or appointment for those who need help making these important decisions.