Q&A on the Medicare drug program

WASHINGTON — Q. After you spend $2,250 and are in the "doughnut hole" - the slice of drug costs that Medicare does not pay - can you change pharmacies for a better discount and save their receipts (even from Canada) until you reach the $3,600 required to gain the catastrophic coverage level of Medicare Part D?

- Anita in Sunrise, Fla.

A: You can switch pharmacies any time you want, but you probably won't get a better discount. Drug plans list certain pharmacies within their network and charge the same amount from one pharmacy to the next. If you purchase a prescription at a pharmacy that is not in the network, the cost is likely to be greater. Purchases from Canada do not count towards your out-of-pocket drug costs under Part D.

Q: I had a liver transplant in November 2004. I received my Medicare, Parts A and B, in December 2005. I was informed that Medicare would not cover cyclosporine, the anti-rejection medicine that I am required to take. The cost of the medicine without insurance is approximately $350. Do you know if any prescription plan will cover part of the expense of this medicine?

- Jim in Austin, Texas

A: Medicare does cover this drug. If you had been covered by Medicare at the time of your surgery, it would have been covered by Medicare Part B, which covers outpatient services. Since you became eligible for Medicare after the surgery, the drug is covered by Medicare Part D.

Using the drug plan finder on the Medicare Web site (www.medicare.gov), I found 48 plans in your area that cover cyclosporine, which is a generic drug. Because it is a generic, most of the monthly prices for the drug were extremely low, including some at no charge beyond the monthly premium.

Q: I haven't signed up for Medicare Part D yet because I am presently covered under my wife's medical plan. She has drug coverage and a letter from her employer stating our drug coverage is as good as, if not better, than Part D. Do I have to contact Medicare to tell them that I currently have coverage for prescriptions?

- Lanneau in Marietta, Ga.

A: No. As long as you have "creditable coverage" through your wife's plan you don't need to enroll in a Part D plan and you don't have to contact Medicare. But be sure to keep that letter from your wife's employer. If you ever lose that coverage, you will need the letter to prove that you did not need to enroll in Part D at this time. That will allow you to avoid the late enrollment penalty.

Q: I become eligible for Medicare in May and have already received my Medicare card with a start date of May. When do I become eligible for Part D, on the first day of May or on my birthday?

- Melton in Atlanta.

A: You can enroll in Medicare Part D three months before your birth month, during your birth month and three months after your birth month. The enrollment becomes effective on the first day of the month after you enrolled. Since your birthday is in May, you can enroll any time from now through the end of August, even though the deadline for those already on Medicare is May 15.

Q: As of now I do not take any prescription medication, only over-the-counter vitamins. I am 75, have Medicare Part A and B and a supplemental insurance policy. Is it really necessary for me to sign up for Part D now? I am afraid that if I do not do anything by May 15, I will be penalized, and that could really get expensive if and when I ever have to take prescriptions.

- Charlotte in Boynton Beach, Fla.

A: Are you a gambler? Do you want to bet that you won't need a costly prescription for the rest of your life? That's the question you have to answer in deciding whether it is worth enrolling now.

I'd sign up for the cheapest plan available. If you do not have any prescriptions, the plan with the lowest monthly premium would be cheapest. But if you do have any prescriptions, the plan with the lowest monthly premium may not be the cheapest because of deductibles and co-pays.

The good thing is that you can switch plans every year.

Q: I take only two prescription medications. When researching plans, I find these two, Premarin and Mavik, are not covered under many plans. To take the cheapest plan I will be paying monthly premiums without any benefits. What is the best solution to this problem?

- Ann in Stuart, Fla.

A: You're right, not all of the 41 drug plans in your area cover both these drugs. But the three least expensive plans, on an annual basis, all cover those drugs. The estimated annual cost for those plans ranges from $512 to $921. Use the Medicare plan finder and the link that compares up to three plans at a time to help find the best plan for you.

Confused about the new Medicare Part D prescription drug program? Cox Newspapers Washington Bureau reporter Larry Lipman answers selected questions from readers. Send your question, with your name and city, to medicaremailbag(at)coxnews.com.