It’s Re-evaluation Time for Medicare Part D Beneficiaries

Dear Savvy Senior,

I have been using the same Medicare prescription drug plan for four years now but my pharmacist told me I needed to switch to a different plan that fits my needs better. What’s the best way to do this? —Swapping Senior

Dear Swapping,
Because Medicare’s "Part D" prescription drug plans can change dramatically from year-to-year, during the open enrollment period (Nov. 15 to Dec. 31), all seniors with a Part D plan should do some comparison shopping to ensure they’re getting the best drug coverage at the lowest cost. Here’s how to do it.

Do-It-Yourself
If you have Internet access, sizing up and comparing your Medicare drug plan with the many other plans that are available to you is relatively easy. Start by making a list of the drugs you currently take along with their dosages. Then go to Medicare’s Prescription Drug Plan Finder tool (www.medicare.gov/mpdpf) and click on "Find and Compare Plans." From there you simply plug in your personal information, zip code, along with the prescription drugs and dosages you currently take, and you’ll get a cost comparison breakdown for each plan available in your area. This tool also provides a five-star rating system that evaluates each plan based on past customer service records, and suggests generics or older brand name drugs that can reduce your costs.

If you find a better deal, before switching plans, there are several other areas you need to double-check to ensure good coverage, including:

  • Total costs: Don’t judge a plan strictly by its monthly premium cost. Low-premium plans are often associated with higher prescription co-payments and may prove to be the costliest plans. So take a look at the whole pricing package, including premiums, deductibles, co-pays and coverage gaps that may apply.

  • Pharmacy network: Make sure the pharmacies you regularly use are in the plans’ network.

  • Drug restrictions:Some plans may require you to get permission or try a number of cheaper drugs before they will cover particular prescriptions. Call the provider to find out!

  • Coverage gap: Find out if your plan will cover any drugs in the coverage gap known as the doughnut hole. Next year, Part D will cover most drug bills up to $2,830, and then you’re on your own until your out-of-pocket cost total $4,550. Some plans offer some gap coverage, but they’re usually limited to generics drugs.

Find Help
If you need some help or if you don’t have Internet access to compare drug plans, or don’t feel confident in working through the information on your own, ask one of your kids or a close friend to help you. You can also call Medicare at 800-633-4227 and they will do the drug plan comparing for you over the phone. Some other helpful resources include the Medicare Rights Center which staffs a toll-free number with counselors ready to help at 800-333-4114, and your State Health Insurance Assistance Program (SHIP) who provides one-on-one free Medicare counseling. To find a local SHIP counselor, visit www.shiptalk.org, or call 800-677-1116.

Extra Help
If your annual income is less than $16,245 for an individual ($21,855 for a married couple living together), you may be eligible for some extra help in paying for your Medicare drug coverage. Call Social Security at 800-772-1213 to see if you qualify.

All-In-One Option
Instead of paying separately for Medicare Part B, plus a Medigap supplemental policy and a stand-alone Part D drug plan you could sign up for a Medicare Advantage plan that provides all-in-one coverage. These plans, which are sold by insurance companies, are generally available through HMOs and PPOs. To find the best deals in your area visit www.medicare.gov/mppf or call 800-633-4227.

Savvy Tip: Be wary of Medicare sales scams. Unsolicited door-to-door sales and telemarketing of Medicare drug plans is illegal. And all legitimate sales agents must be licensed by your state — you can check this at your state insurance department (see www.naic.org/state_web_map.htm).