Navigating Medicare Drug Plans
CBS News correspondent Wyatt Andrews offers some tips on how to weed through the registration process for the Medicare prescription drug benefit. The enrollment deadline is May 15, 2006, after which monthly penalties may be applied.
We all know the new Medicare drug benefit, called Medicare Part D, is terribly confusing. Some states have more than 40 different plans, all offered through private insurance companies, and each is competing for your enrollment with different prices and coverage packages.
OK, It's Confusing! Now, How Do You Sign Up For It?
What follows is the best, step by step list of "how-to" pointers I can come up with after consulting with Medicare, with several insurance companies, and with non-profit groups that follow issues related to aging.
I won't sugar coat this. Finding the best deal will be work, but the upside is that, for a reasonable cost, you will be protected for life against a catastrophic loss of income or assets due to the cost of drugs.
So here goes.
- Before doing anything, make a list of the drugs you take, the dosage amount of each drug and the pharmacies you normally use. Have your Medicare number ready. If you have drug coverage now, through a retirement plan, your union or your employer, have the details of the plan ready, even if you have a notice telling you it's a "creditable" plan.
- If you are internet capable, go to www.medicare.gov. In the middle of the opening page, click on "Compare Medicare Prescription Drug Plans." This will get you started.
- If you are not Internet capable, then, with your list ready, call 1-800-Medicare, which is 1-800-633-4227. They have solved most of the long-wait problems you may have heard about. TTY users should call 1-877-486-2048.
- Either on the Web or with the Medicare phone counselor, enter your list of drugs, dosages and pharmacies.
- At this point, take a minute to determine if Medicare Part D is better than the coverage you have now. If your current coverage is superior, and you've been informed your current coverage is "creditable," you don't need to sign up for Medicare D.
- If, however, Medicare D is for you then the Web site or the phone counselor will give you a list of four or five insurance company plans that cover your drugs and your pharmacies in your state. They will quote you the yearly costs from each plan. Write down the phone numbers of the selected plans and the out of pocket cost quotes.
- Now you have an important choice. If you like what you are hearing from the Medicare counselor, or seeing on the web, you can enroll directly at this point. Or you can keep shopping.
- If you decide to shop, call the selected plans directly. Confirm the coverage of your drugs and pharmacies and confirm the cost quotes you got from Medicare. If the plan is promising no deductibles, confirm this.
- When you shop, you should ask these plans if they require pre-authorization of your drugs. Pre-authorization of a covered drug is a hurdle you may not want.
Make your selection based on the following criteria:
Then enroll!
CRITICAL TIPS
Ask Your Doctor About Generics
Whatever plan you pick, you should know that the plan will be working hard over the next few years to push you to take the least expensive drug in each treatment category. However, switching is in your interest too — if your doctor agrees. Because the Medicare benefit has a coverage gap, meaning you pay most of the costs, switching yourself to cheaper or generic drugs now will make your benefit last longer. Consumers Union, in a report released this week, calculates some seniors can save more than $5,000 in benefits by doing this.
Ask A Friend, Child Or Grandchild For Help
Most experts I've checked with say the Medicare Web site, after a rough start, has worked out its glitches and is a great resource. The problem, of course, is that most seniors (an estimated 70 percent) don't or can't navigate the Internet. If this is you, ask for help. It will save you time and trouble.
Find Out If There Are Seminars Near You
There are major resources being devoted to explain this benefit to seniors. Local, state and federal offices on aging are offering seminars and even computerized sign up sessions — and so are the individual insurance companies. Ask at your county/city office on aging or the local senior center where and when these seminars are being held. For example, I just attended one in Chapin, S.C., where officials from Medicare and the Lt. Governor's office sat at laptop computers and were directly signing people up.
Sign Up Even If You Are Healthy Now
Are you the very vision of health? Not taking any drugs? Excellent! But you should still join the program. After May 15, if you have not signed up, most people will get hit with a one percent per month penalty to join later. If you slip and fall three years from now and then try to join the system to pay for your expensive drugs, you could pay a 36 percent surcharge for life. (This calculation is based on three years after May 15.) Some people disagree on this, but my advice to the currently healthy is to sign up for the cheapest plan you can right now. This is insurance after all. Buy it for the same reason you insure your house or your car.
Seniors On Medicaid Be Alert!
If you are a senior on both Medicare and Medicaid and you get drugs through Medicaid, be aware that Medicare is taking over your drug coverage. If you do nothing, Medicare will make the switch for you and your coverage will begin automatically Jan 1. However, the system may well switch you into a coverage plan where certain co-pays will be demanded. Pay attention to any letters you receive. If you do not like the plan they give you, you are allowed to switch.
Don't Rush — But Don't Procrastinate, Either
As we publish this in mid-December, there is no need to rush. You have until May 15 to sign up without that 1 percent penalty. Just remember that your coverage won't begin until the first day of the month after you sign up. Also, after May 15, there's a no sign-up period that lasts until Nov. 15, 2006, and your coverage would not begin until Jan. 1, 2007.
Low Income Assistance
If you are a low income senior ($14,355 individual, $19,245 couple) you may qualify for a Medicare drug plan with almost no out of pocket expense. It's very important that you tell the phone counselor if you fall in this low-income category.
GREAT WEB SITES
www.medicare.gov — The official Web site for Medicare information and the home of the Medicare Personal Drug Plan Finder.
www.mymedicarematters.org — Offered by The National Council on the Aging and the Access to Benefits Coalition, this Web site features "7 simple steps" to signing up — as opposed to the 10 I offer — but goes into much greater detail.
www.aarp.org — After you reach the opening page, look mid-way down on the right and click "Medicare Rx Coverage." Be aware, AARP is offering one of the plans competing for your business, but the Web site has very good neutral information on the benefit itself and how to sign up.
www.kff.org — Offered by the Kaiser Family Foundation. From the opening page, look down to the left and click "Medicare."
www.webmd.com — This is a little harder to find, but very good. From the opening page, first click "health care services" on the first green line of choices, then click on "Medicare benefits."
www.CRBestBuyDrugs.org — From Consumers Union. This Web site lists the cheapest and most effective drugs for several treatment categories. After you reach this page, click on "drug reports."
www.eldercare.gov — For access to local counselors who can help you evaluate your options.
By Wyatt Andrews