Special coverage: Medicare

Find wealth of information on Medicare's site

A much-improved Web site shows you the ins and outs of the plans. Just pick and click.

By STEPHEN NOHLGREN, Times Staff Writer
Published November 27, 2007

A much-improved Web site shows you the ins and outs of the plans. Just pick and click.

People on Medicare have a multitude of drug and health plans from which to choose for 2008. As an example, in the Tampa area, there are 151 drug and health plans.

Thank goodness for computers.

The best way to find plans that are right for italics you is to go online.

That's because Medicare's Web site allows you to enter the specific drugs you take and see what each plan would cost you. The difference in prices of medications can dramatically alter the cost of the various plans.

Computer searching may sound imposing, and in past years, Medicare's Web site was difficult to navigate. But this year, the site is much improved. It still requires effort, but it delivers more useful information in a better package. And make sure your computer is connected to a printer. You will need to make printouts of the various plans you consider.

If you aren't comfortable with computers, try to find a relative or friend to conduct a search for you. A few non-profit services can also help.

A thorough search might take 30 to 40 minutes, but the results will be tailored to your particular case, and that might save you hundreds, if not thousands, of dollars and will help you avoid plans with poor performance records.

Here is a step-by-step guide to using Medicare's Web site:

1. Go to www.medicare.gov.

2. For standalone drug plans, click on "Medicare Prescription Drug Plans - 2008 plan data" and follow steps 3 through 20. For HMOs, PP0s and Private Fee For Service plans, click on "Medicare Health Plans - 2008 plan data" and follow steps 21 through 33.

For standalone plans:

3. Next page: Click on "Find & Compare Plans." (Ignore the drop-down box that asks you to select a state. You will be entering your ZIP code soon.) This page also lets you "View Your Current Plan" for 2007 if you like, but that isn't necessary.

4. Next page: Click on "Begin General Search." (You can ignore the personalized search function for now.)

5. Enter your ZIP code, but skip the boxes where it asks your age and health condition. Fill in the other three check circles. Click on "Continue."

6. Next page: Read this information if you like, or just the "Continue" box at the bottom of the page.

7. Next page: Click on "Enter My Drugs."

8. Next page: Enter your drugs in the box. When you are done, click on "Save My Drug List." This step is not necessary but useful. It will give you an identifying number you can use to re-enter your drugs automatically if you do a new search later.

9. Next page: Change the specific doses and frequency of your drugs if the computer fails to list them accurately. Then "Continue."

10. Next page: The computer will ask if you want to select a specific pharmacy. Answer "No." Most drug plans have plenty of pharmacies. If you do have a favorite pharmacy, you can double-check later to make sure that a specific plan works there. But if you narrow your search to a specific pharmacy at this point, you may skew the cost results.

11. Next page: This is the initial drug plan list, in order of the cheapest plans for someone using your specific drugs. The dollar figures are what you can expect to pay out-of-pocket, including premiums, deductibles and the cost of the drugs.

When you call Medicare or other agencies for help, they typically stop at this step and tell you what the cheapest plans supposedly are. However, this list can be deceptive because other plans may be a lot cheaper if you substitute brand names for generics or one brand for another or if you order you drugs by mail.

Do not stop at this step. Instead, go to the bottom of the list where it lets you see 10 or 20 or all the plans at once. View at least the top 10 or 20 plans on this initial list. Then print the list so you can use it to take notes.

12. Now check the individual plans. Do this by clicking on the name of a plan that interests you. It could be the cheapest plan, or maybe one offered by a company you trust.

A box at the bottom of the initial plan list allows you to compare three plans simultaneously. Do (italics) not do this. Rather, analyze one plan at a time. It will take a little more time, but you will get better information.

When you click on an individual plan it will take you to a "plan details" page. From there, follow steps 13 through 19 for each plan that interests you, taking notes on the initial plan list that you printed out.

13. At the bottom of the plan details page, a bar chart shows your month-by-month costs. If your costs jump dramatically, that is the month where you will enter the "coverage gap" - the so-called "doughnut hole." If costs drop down dramatically, that is when you will emerge from the gap.

14. The top left of the plan details page contains a blue box called "Basic Plan Information." Click on "Lower My Share Cost."

Some plans offer considerable savings if you switch to a generic drug or switch brands. You should calculate these possible savings for each plan because plans that appeared to be expensive on the initial plan list may actually be a lot cheaper if you accept these drug substitutions.

The "Lower My Share Cost" page lists your monthly costs with and without the suggested savings. You have to do some subtraction to find out the dollar amount of the monthly savings. Then, multiply by 12 for the annual savings.

Make a note of this annual savings on your printout of the initial plan list, next to the name of that plan.

At the top right of the "Lower My Share Cost" box is a link that lists further savings if you buy your drugs through 90-day mail order. Again, this box allows you to calculate possible cost savings that you should note on the initial plan list. Do this for five to 10 plans that interest you. That will give you a more accurate picture of your out-of-pocket costs if you take advantage of what different plans offer.

One word of warning: Consult your doctor before picking a plan based on cheaper substitute drugs. Make sure such changes are appropriate for you.

15. Go back to the plan details page. At top left, click on "View Pharmacy Network." A new window will open when you do this. Make sure the plan has a pharmacy you like. Note that you can change the geographic breadth of your pharmacy search.

16. Go back to the plan details page. Click on "View Important Notes and Benefit Summary." Again, a new window will open. This tells whether you can use the plan in other states - important for snowbirds.

17. Go back to the plan details page. Go down to the fourth blue box marked "Drug Coverage Information." This will tell you if the plan places special restrictions on your drugs.

Prior authorization means your doctor must get approval in advance from the plan before it will cover your drug. This can be a burden. Quantity limits means the plan can restrict the number of doses over a period of time. This is usually to make sure you don't overdose, and generally it is not a problem.

Step therapy means the plan can require you to try a substitute drug before covering your drug of choice. This, too, can be a burden. Evaluate how important any such restrictions are to you. Perhaps a slightly more expensive plan will not have such restrictions.

18. At the top right of the page, click on "Get Plan Performance Information." Medicare is such an easy grader that anything less than 3 stars may signal a problem. Weigh your tolerance for aggravation vs. the plan's cost.

19. Write down the phone number for nonmembers, in case you pick this plan. That's how to enroll.

20. Repeat steps 13 through 19 for each plan that interests you, using your printout to take notes. Balancing cost, performance, drug restrictions, pharmacy convenience, pick a plan that's best for you.

For HMOs, PPOs and Private Fee for Service:

21. Next page: Click on "Find & Compare Health Plans."

22. Next page: Click on "Begin General Plan Search." (You can ignore the personalized search at this point unless you want information about your 2007 coverage.)

23. Next page: Enter your ZIP code, age range and health status. Fill in other circles as appropriate and click "Continue."

24. Next page: Read any of this information you want, then click on "Continue" at the bottom of the page.

25. This page gives you the initial list of HMOs, PPOs and Private Fee for Service plans for someone like you. It appears to list the cheapest plans first but that can be deceptive, because it doesn't take into account how different plans charge for your particular drugs. You have to dig deeper.

Print out this page for taking notes. Then, using the selection boxes at the left of each plan, choose three plans that interest you, scroll to the bottom of the page and click on "Compare." (Remember: HMOs, PPOs and PFFS plans are mixed together on the initial list. Make sure you pick the types of plans you want.)

26. Next page: This is a grab-bag of plan details, including out-of-pocket spending limits, whether the plan lets you get treatment out-of-network and how the plan handles dental coverage. The "View Details" option under each plan gives even more information.

27. Go to the right of the page, under the green "Learn More" button. Links to "View Quality and Satisfaction Graphs" and the "View Performance Matrix" show how people with these plans rate their quality of service. Some plans are too new to have a track record. A new window will pop up that lets you select the quality measures you want to examine.

28. Go back to the three-plan comparison page, and just above "Learn More" click on the brown box "Enter Your Drugs" and follow those instructions. This can dramatically alter a plan's costs. A plan that appears cheapest on the initial list might cost an extra $2,000 a year because your specific drugs are more expensive under that plan.

After you enter your drugs and dosages, a screen will offer you a "Save Your Drug List" option, which gives you an ID number that will remember your drugs for future comparisons. Take that option and write down the ID number.

When the computer asks if you want to pick a specific pharmacy, click "No." You can check on pharmacy availability later. Picking one now could badly skew the results.

29. When the computer leads you back to the three-plan comparison, it will now be called "Your Personalized List." Note the "Estimated Annual Cost" column, which is highlighted in green at the top. This is the cost of your specific drug coverage under each plan.

Some plans might charge nothing extra while another charges $2,500. This is not a mistake: Plan formularies can vary that dramatically.

Make note of extra drug costs on the printout you made of the initial plan list. (For a neat visual presentation of costs, click on "Compare Drug Cost Details" at the bottom of the page, then click on "View Plan Drug Details" in the drop-down box. That will plot your drug costs through the year, including the infamous doughnut hole.)

30. For plans with expensive drug costs, click on the "Lower This Cost" link under the dollar amount on the "Your Personalized List" page. This step will give you possible savings if you switch to generics or preferred brands.

Click on the red link titled "Similar drug" to see what the substitution would entail. Consult your doctor before picking a plan based on these substitutions.

31. For each plan that interests you, click on its name. On the next page, look for "Basic Plan Information" at upper left. The "View Pharmacy Network" function will list nearby pharmacies that take the plan. The "View Important Note" and "Benefit Summary" function will show whether you can use the plan in other states.

32. After checking the first three plans, go back to the initial plan list and check three others. You can't return to the initial list by hitting the back button: You have to click on a tiny link at top left. It will say either "Back to List of All Plans in Zip" or "Back to Plan Search Results."

Because your drug costs can vary so widely between plans, you may have to research lots of plans to find one that truly fits your pocketbook.

33. After balancing all the information you have gathered, pick the plan that suits you best and telephone the company to enroll.

[Last modified December 5, 2007, 22:09:57]