Medicare Part D prescription drug benefit open enrollment runs through Dec. 31. During that time, if you are covered by Medicare, you can add, drop or change your prescription drug plan for coverage that begins Jan. 1, 2010. If you are happy with your current plan, you do not need to do anything for your enrollment to continue, but you still should review that coverage for changes and consider if another plan may be better.
Since plans change each year, you should annually review your prescription drug needs and compare Medicare drug plans - including your current plan - for cost, coverage and convenience. Some of these factors might be more important to you than others, depending on your situation and prescription drug needs.
When you get Medicare prescription drug coverage, you pay part of the costs, which will vary by plan, and Medicare pays part. Your premium is the monthly cost you pay to join a Medicare drug plan. While the plan with the lowest premium may be tempting, be sure to investigate what the plan will cover. You will be responsible for other costs.
Your deductible is the amount you pay for your prescriptions before your Medicare drug plan starts to share in the costs. No Medicare drug plan may have a deductible more than $295 in 2009 and some drug plans may not have any deductible. Your copayment (a set amount) or coinsurance (a percentage of the cost) is the amount you pay for your prescriptions after you have paid the deductible. In most Medicare drug plans, you pay the same copayment or coinsurance for any prescription. In other drug plans, there might be different levels or “tiers” of prescriptions with different costs.
Various drug plans can have different formularies, which is the list of drugs that a plan covers. In general, the formulary must include at least two drugs in all categories and classes of drugs used by people in Medicare, ensuring that people with different medical conditions can get the treatment they need.
Some Medicare drug plans have a coverage gap, also know as the doughnut hole. You reach the coverage gap when you and your Medicare drug plan have spent a certain amount of money for covered drugs. While you are in the coverage gap, you have to pay all costs for your drugs, in addition to your monthly premium. For plans with a coverage gap, the most you will ever have to pay out-of-pocket before you are out of the coverage gap is $4,350 in 2009. Ohio offers at least one Medicare drug plan with some type of coverage during the gap for an extra premium.
Medicare drug plans contract with pharmacies, so check that your preferred pharmacy or a pharmacy convenient to you is under contract with your plan. Also, some Medicare drug plans may offer a mail-order program that will allow you to have drugs sent directly to your home. You should consider all of your options in determining what is the most cost-effective and convenient way to have your prescriptions filled.
Comparing Medicare drug plans is essential to ensure the plan you choose will meet your prescription needs. It can seem overwhelming, but help is available. Call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov and select “Compare Health Plans and Medigap Policies in Your Area.”
You also can call the Ohio Senior Health Insurance Information Program (OSHIIP) at 1-800-686-1578 to receive a free comparison of the prescription drug plans available in Ohio and an explanation of other programs that may help pay drug costs.
Even if you don’t take a lot of prescription drugs now, you still should consider joining a Medicare drug plan. As we age, most people need prescription drugs to stay healthy. Joining gives you peace of mind knowing you have coverage if your drug needs change.