Get started on Medicare drug sign-up
Seniors, don’t wait until the last minute to sign up for 2009 prescription drug coverage through Medicare. Doing so could limit the time you have to wade through options and delay your enrollment, creating hassles at the pharmacy counter as 2009 begins.
“Each plan can differ on premiums, deductibles, co-pays and the drugs they cover. Take time to read through the plans and to call plan representatives for additional information,” says Paul Precht, policy and communications director for the Medicare Rights Center, an advocacy group based in New York City and Washington, D.C.
Drug coverage, known as Medicare Part D, was launched in 2006 for people 65 and older with no other prescription drug insurance and for younger people receiving Social Security benefits. It offers myriad private health insurance plans from which to choose, each with different cost and drug choices.
The sign-up period for next year’s coverage began Nov. 15 and ends Dec. 31. (Turning 65 in 2009? You can sign up from three months before your birthday until three months after, even if that date is after Dec. 31.)
Anyone who was covered under a Medicare Part D prescription drug plan during 2008 should have received information by mail by Oct. 31, with details on any changes to the plan, including cost increases and drugs no longer covered. Didn’t get the information? Call the plan to get the scoop for 2009. Significant price increases should push beneficiaries to look for other options, Precht says.
Do nothing and you’ll be automatically enrolled in the plan you had last year, if you were in a plan last year. ere are some key changes to Medicare Part D for 2009:
Expect cost increases
“Even people who [were happy with their 2008 plan] need to review their options,” said Robert M. Hayes, president of the Medicare Rights Center. “They should not assume their plans will remain the same in 2009, as most plans change their costs and benefits every year.” According to Avalere Health, a corporate health advisory firm based in Washington, D.C., consumers who remain in their current plan will see a 24% increase in their monthly premiums for 2009.
Help for doughnut hole
The “doughnut hole” may be Part D’s most recognizable term. It refers to a coverage gap for many beneficiaries (excluding those with very low income) that happens when out-of-pocket costs and the plan’s costs together reach a certain amount. The patient then has to pay all the out-of-pocket costs until a specific amount is reached. For 2009, the doughnut hole begins at $2,700 and continues until out-of-pocket costs reach $4,350. Above that, individuals pay a very small co-pay for drugs. For 2009, according to Stuart Guterman of the Commonwealth Fund, a foundation that advocates for health reform, many plans are paying at least some of the cost for generic drugs during the coverage gap, and some are paying for a share of brand-name drugs as well.
Prices of some specialty drugs will rise steeply
A report issued by the Office of the Inspector General of the Department of Health and Human Services, which oversees Medicare, found that some Part D plans have raised prices for some drugs used to treat certain serious conditions such as anemia, hepatitis C and some cancers to as much as 50% of the cost of the drug.
Some cancer drugs will be added to coverage
Some cancer drugs used off-label (meaning they’re not approved by the Food and Drug Administration for a particular use but might be effective) may be covered.
Ask your doctor if your drug is prescribed off-label and, if it has not been previously covered, whether your plan can be contacted to see if the drug qualifies this year, says John Carlsen, a principal with Covance, a drug development services company based in Princeton, N.J.
Consider bypassing the plans for some generics
Though generic drugs are likely to be the least expensive option in any Medicare Part D plan, some chain store pharmacies may offer the drugs for even less. CVS, Walgreens and Rite Aid, for example, are all offering about 400 generic drugs for about $3 to $5 per month. (CVS charges an annual fee of $10; Walgreens, $20 per individual, $35 per family; Rite Aid’s card is free; each card comes with additional discounts at the pharmacy’s stores.)
So long as a pharmacy chain is in the Part D plan’s pharmacy network, the drugs you buy will count toward your deductible, says Precht of the Medicare Rights Center. Keep receipts in case you need to submit proof of purchase.
(The new savings plans at pharmacies don’t cover all generic drugs. CVS, for example, includes the generic cholesterol-lowering drugs lovastatin and pravastatin in its low-cost program, but not simvastatin, the generic version of Zocor.)
Be careful when opting for brand names
Some Part D plans will charge a penalty for beneficiaries who opt for a brand-name drug when a generic version is available -- and that extra fee is not always flagged when beneficiaries check the drug prices of a plan.
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Do the research
Here are a few good starting points on Medicare Part D:
GETTING STARTED
New to Medicare Part D in 2009? Start at www.medicare.gov and click on Prescription Drug Plan, on the left, or call 800-MEDICARE (633-4227) for a compendium of all things Part D.
Part D veteran? Head right to plan comparisons at Formulary (Drug) Finder. This option lets you compare the premiums, deductibles and drug co-pays for plans in your area. But the task is tedious. A recent search for a plan that covered just a single drug took 20 clicks on the site.
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WHO CAN HELP
The website My Medicare Matters, offered by the National Council on Aging, presents the very complex Part D information in simple terms and divides it into digestible chunks before sending you off to the next section.
The Medicare Rights Center, an advocacy group based in New York and Washington, D.C, offers Medicare Part D telephone counseling from 9 a.m. to 6 p.m. (EST) Monday through Friday. The group’s website offers plenty of information as well.
The National Alliance for Hispanic Health, an advocacy group, can answer questions about Part D benefits for Spanish-speaking beneficiaries. Call (866) 783-2645, from 8 a.m. to 6 p.m. (EST) Monday through Friday.
California Health Advocates is a nonprofit Medicare education and advocacy group. Its site is well-written, but a little highbrow, with lots of acronyms, and is best used by Medicare-savvy beneficiaries and caregivers who have a good handle on basics.
The Health Insurance Counseling and Advocacy Program (HICAP), run by the California Department of Aging, offers one-on-one counseling on Medicare, managed care and long-term care. A call to (800) 434-0222 is routed to the closest office.
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LOW-INCOME AID
Medicare offers financial assistance to low-income beneficiaries. Contact Medicare Extra Help to find out the qualifications for the program. Then go to BenefitsCheckupRX, and click on Apply for Medicare Rx Extra Help, or call 800-MEDICARE (633-4227).
Information on low-income assistance is available on the California Health Advocates website (see above). Click “Low-income help” to the left of the home page.
HICAP operators (see above) also answer questions and provide resources.
-- Francesca Lunzer Kritz
