The new Medicare drug coverage can save you money, but figuring out how to get the right plan for you can be tricky. Here's help.
By STEPHEN NOHLGREN, Times Staff Writer
Published December 4, 2005
If nothing else, Congress has created a raft of new choices for people on Medicare. Here are step-by-step recommendations to help you navigate the new drug maze.
STEP 1: HMO VS. TRADITIONAL MEDICARE
Medicare HMOs generally offer doctor and hospital services that cost less than traditional Medicare, though you usually must stick to the doctors and hospitals in an HMO network. They are also an inexpensive way to get prescription drugs, because many do not charge an extra monthly premium.
If you are comfortable with an HMO or other network-type program, go to steps 7 to 9, which compare the HMO plans in the Tampa Bay area.
If you prefer traditional Medicare's Part A and Part B, in which you pick your own doctors and hospitals, proceed to Step 2.
If you previously joined an HMO primarily to get drug coverage, Medicare's new rules now give you a chance to return to traditional Medicare and pick up drug coverage with a standalone Part D (prescription drug) plan. Keep in mind that with traditional Medicare, you may need to buy a supplemental policy.
If you are unsure whether you want traditional Medicare or an HMO, measure the cost of traditional Medicare by following steps 2 through 6. Then compare that with HMO costs listed on Page .
Do not enroll in both an HMO and a drug plan.
STEP 2: CHECK ANY EXISTING DRUG COVERAGE
If you already have good drug coverage through a former employer or union, you probably should keep that coverage if it is deemed "creditable," which means its benefits are at least as good as a Medicare Part D drug plan's benefits.
Your former employer or union is supposed to notify you whether or not your plan is "creditable." If you have not been notified, contact them. Tricare, VA and Federal Employee Health Benefits coverage are all creditable plans.
If your plan is not creditable, you probably should switch to an HMO or a Part D drug plan; that's because you will have to pay a premium penalty if you want to switch later, even if it's because your employer drops coverage.
If you have a Medicare supplement policy with drug coverage, switch to a cheaper one without drug coverage and join a standalone Part D plan. Supplemental coverage is never as efficient as the best Part D plan.
If you get drugs free from the manufacturer through a prescription assistance program, you probably should sign up for a Part D plan. Many of those aid programs will end for people on Medicare once the drug benefit starts in January (please see story, Page ).
STEP 3: WHAT IF I HAVE NO COVERAGE?
Anyone without current coverage probably should enroll in an HMO or Part D plan - even if your health is good and you never need to use it. Plans can cost less than $132 a year, a small price for protecting yourself against a sudden, expensive illness. Also, if you reject drug coverage now, you will pay a substantial premium penalty if you want to join later.
If your income and assets are limited, you may qualify for "special help" subsidies. (See income guidelines and application rules, Page ??)
STEP 4: COMPARE DRUG PLANS
The charts on the following pages can give you a general idea of what different plans cost. You must factor in the monthly Part D premium, which you will pay in addition to the Part B premium that Medicare takes out of your Social Security check. You must also add in any annual deductible and copayments. Most plans also require you to pay 100 percent of all drugs in the "coverage gap," which usually starts when annual drug costs hit $2,250 and ends when they reach $5,100. Above $5,100, your plan re-establishes coverage at little cost to you. If consulting the chart makes your head spin, proceed immediately to Step 5.
STEP 5: CONSULT MEDICARE
Medicare has a service called Drug Plan Finder, which takes a list of your medications, runs it through Medicare's computer and spits out your total cost under each of Florida's standalone plans. That will help you decide which plan is best for you.
You can operate the Drug Plan Finder yourself by visiting www.medicare.gov Though this site experienced serious slowdowns in its first few weeks, it has since operated much more quickly. A complete search will take 45 to 60 minutes. Instructions are on Page ??.
You can also call Medicare toll-free 1-800-633-4227 and talk to a live person who can run the Drug Plan Finder for you. Medicare's phone answerers are trying to dispatch calls quickly, and a thorough search takes time. Read the calling instructions on Page xxxx to make sure the Medicare employee serves you well.
Florida's SHINE program and other advocates can also help you with a personal computer search.
STEP 6: THREE KEY QUESTIONS
Before you sign up with any drug plan, make sure that:
1. It covers all the drugs you take.
2. It can be used at a pharmacy you are comfortable with (most plans work at most chain drugstores and grocery stores).
3. You can fill prescriptions in other states if you spend significant time outside Florida.
STEP 7: ENROLL
If you want coverage as of Jan. 1, you must enroll by Dec. 31. After narrowing your choice to the top three or four plans, call the companies directly and verify that their plans will cover all your drugs and what your total annual cost will be. Company telephone numbers are listed on the charts on pages 12-14.
Based on cost and access to your drugs, enroll with the plan that suits you best. You can enroll through the company, on www.medicare.gov or by calling Medicare's hotline at 1-800-633-4227. You have until May 15 to sign up without penalty, but your coverage will not start until after you sign up.
STEP 8: CHANGE YOUR MIND?
Since these are big changes, Medicare offers a one-time chance in 2006 to change your mind without penalty. If you sign up for an HMO or standalone drug plan, you can pull out or change plans any time before May. 15. After that, you are locked in for the rest of 2006. In late 2006, you can make your choice for 2007.
If you receive drugs through Medicaid and also qualify for Medicare, your Medicaid coverage will end Dec. 31 and the government will enroll you in a Medicare drug plan and notify you of its name. Call this company to make sure it covers your drugs. If not, you can switch to a different plan. In fact, you can switch between plans every month between now and May 15. Only this Medicaid group can switch plans monthly. Others get only one chance to switch.
STEP 9: EXHALE
Though this seems like a lot to chew over, resist the urge to rush. You still have a few weeks to sign up and have coverage begin in January. You have until May 15 to enroll without incurring any premium penalty later.
Move quickly on only one wrinkle: low-income assistance. If you think you might qualify for a special help subsidy, read the story on Page xx and call the Social Security Administration immediately to apply. Medicare expects an end-of-the year surge in applications, which would be good to avoid if you can.
