DEL.ICIO.USThe Atlanta Journal-Constitution
Published on: 02/09/06
DRUG PLAN, STEP BY STEP
If you're considering Medicare's prescription drug coverage, there are plenty of dates, prices and conditions to keep in mind.
|  | ||
|
MOST POPULAR STORIES
EMAIL THIS
PRINT THIS
MOST POPULARWhile all 1 million Georgians on Medicare are eligible, the coverage did not just automatically kick in Jan. 1...If you want it, you must enroll, unless you are also on Medicaid. You can enroll as late as May 15. If you enroll past May 15, however, you may face a penalty.
The core of the new law is that private insurers will offer prescription drug coverage to seniors and those with permanent disabilities on Medicare. ..
In some cases, you may find that you have better or less expensive coverage through your current plan, such as a former employer plan. If so, you may elect to skip the new coverage.
It sounds difficult at first, because there are so many categories and contingencies to consider. No one plan fits every person. But with help, there's a way to cut through the confusion.
1. What's your current coverage?
None: You can save money by checking out prescription drug coverage through Medicare.
Through Medigap: Compare premiums of new plans and their coverages with what you have now...Generally, though, you'll likely get better drug coverage through a Medicare plan.
Through a current or former employer or union: Find out if your current coverage is as good as that required by Medicare. Your employer should be able to provide that information. Compare your coverage with the new Medicare plans. Your current coverage may be better.
Through a Medicare HMO or other managed care provider: Check out what your plan is offering and compare to coverage offered through a regular Medicare drug plan. You may decide to stay with your current provider, or switch to another HMO, or perhaps pick a separate drug plan and move into traditional Medicare.
Through Medicaid: Medicaid stopped paying for drugs for seniors on Jan. 1, and you're getting coverage through Medicare. You will have a choice of which new prescription drug plan to enroll in. If you didn't pick one by Dec. 31, Medicare chose a plan for you. Compare plans closely, always keeping in mind any health conditions you have and how many prescription drugs you take.
Through Veterans Administration, or a military health plan: Your plan is not changing. It will likely be to your advantage to keep your current plan.
2. The first three questions are easy and basic:
What is your income?
A single person whose income is up to $14,355 a year or a married couple living together whose income is up to $19,245 may qualify for a special —- and very inexpensive —- Medicare drug plan. It has very low out-of-pocket costs. If you already receive government assistance through Medicaid, Medicare Savings Program or Supplemental Security Income, you will automatically qualify. If not, you will need to apply for it with Social Security. You can go in person to your nearest Social Security Office, apply by mail, or call 1-800-772-1213. On the Internet, go to Social Security.
What medications do you take?
Make a list of all your prescription medication, their dosages and what you pay for them. Total the amount you pay per year. Note that plans may not cover all the medicines you now take. You may want to talk with your doctor to see whether an alternate, cheaper drug might work just as well. The drugs you are taking will be a big factor in your decision.
What is your ZIP code?
The policies offered to you might vary based on where you live in Georgia.
3. Here's where personal preference comes in. Think about each of the following factors and decide for yourself what's important to you. Doing this will help narrow the choices you'll have to make later.
What is a comfortable monthly premium for you?
The new Medicare plans require that you pay a premium, or a monthly fee, to a plan provider. The average premium for 2006 in Georgia is about $33 a month. Some will be more, and some will be less. When you compare plans, be sure to compare the premiums. Remember that the amount you pay for the premium will not be considered as part of your deductible. It is an out-of-pocket expense.
How high or low should your deductible be?
Most plans will require that you meet a deductible, or a set amount of money determined by the insurer, before the plan begins to help pay for the cost of your prescriptions. The deductible can be no higher than $250, but some plans may be lower...After you meet the deductible, many plans will cover 75 percent of the next $2,000 of your covered drug costs.
Are you affected by the "Doughnut Hole"?
This is a soft way of describing the danger zone in many of the new plans. The hard fact is this: when your drug costs reach between $2,250 and $5,100, you will generally be on your own. This coverage gap is especially important to consider if you take several medications and have several chronic conditions.
Do you prefer to receive your medicines through the mail?
If it's important to you to have mail-order drugs, make sure the plan you're considering offers that feature. Also, discuss with your doctor if you are going to enroll in a mail-order plan. You need to be prepared to handle the paperwork —- getting the prescription, mailing it in so that you get your medicine before you run out, keeping track of the out-of-pocket costs if a deductible is involved.
Are you loyal to a particular pharmacy?
Some plans will mandate which pharmacies you can use. If your relationship with your current pharmacy is important to you, you will need to make sure it is on the list of approved pharmacies. If not, carefully check out the pharmacies that are on the plan to make sure you will feel comfortable with them. Also, consider the distance to specified pharmacies. Will an extra drive —- and gas money —- be worth saving a few dollars?
4. Now you are ready to begin comparing plans. Here's where to go:
• Call 1-800-MEDICARE.
• Try the Medicare Web site, Medicare.gov
• Call GeorgiaCares, an information and insurance counseling service, at 1-800-669-8387.
• Consult the "Medicare and You" handbook.
• Consult a trusted community group.
• Ask friends or family members for help.
Attention! Make sure you check drug lists along with the price comparisons. Remember, this is huge!
Insurance companies compile lists of prescription drugs for which they will reimburse. If a drug you take is not on the company's formulary, the insurer generally will not cover it. You may gain little to pay a premium for a policy that covers only some of your medications, or one that covers the least expensive drugs you need but leaves you holding the bag for the big-ticket ones.
Take your time: The array of choices is confusing, and you should fully explore what picking one particular option actually means. Also, keep in mind that you have until May 15 to enroll without facing a possible penalty for late enrollment.
Be careful: You may get confused by differences between drug coverage through traditional Medicare and through a Medicare health plan that can operate like a HMO. (Medicare calls these Advantage plans.) Choosing drug benefits through one of the managed care plans may mean a drastic change for you —-different deductibles for medical care and limits on your choice of doctor or hospital.
Glossary
DEDUCTIBLE: The amount you pay out of pocket on prescriptions before your insurance coverage starts.
DOUGHNUT HOLE: The gap in a Medicare drug plan where you get no coverage — generally after drug costs have hit $2,250. For the next $2,850 in spending, the plan pays nothing toward your costs. But some plans may narrow or eliminate this gap.
FORMULARY: The roster of prescription drugs that are covered by your plan.
MEDICARE ADVANTAGE: Health plans, such as HMOs and preferred provider organizations, that operate as an alternative to traditional Medicare coverage. They may restrict your choice of doctors.
MEDICARE PART D: Medicare's new drug benefit, which debuts Jan. 1.
PREMIUM: The monthly amount you pay in order to get coverage.
Sources: GeorgiaCares, AARP, Centers for Medicare and Medicaid Services
Services »
