How to pick the best Medicare prescription drug plan for you

October 11, 2011 

I recently received a letter from my Medicare “Part D” prescription drug plan provider notifying me that my premiums and co-pays will be increasing next year, and they are dropping coverage on one of the drugs that I take. How can I find a better drug plan?

-- Frustrated Senior

Because Medicare’s prescription drug plans can change their costs and benefits from year-to-year, comparing Part D plans every year during the open enrollment season (which is now Oct. 15-Dec. 7) is always a smart idea. Here are some tips and resources to help you find the best drug coverage at the lowest price.

Do It Yourself

If you have a home computer and Internet access, comparing your current Medicare drug plan with the many other plans that are available, and enrolling in one, is something you can do yourself.

Just go to Medicare’s online Plan Finder Tool at www.medicare.gov/find-a-plan, and type in your zip code or your personal information, the drugs you take and their dosages, and select the pharmacies you use and you’ll get a cost comparison breakdown for each plan available in your area. This tool also provides a five-star rating system that evaluates each plan based on past customer service records, and suggests generics or older brand name drugs that can reduce your costs.

When comparing drug plans don’t judge a plan strictly by its monthly premium cost. Low-premium plans are often associated with higher prescription co-payments and may end up being more expensive. So take a look at the whole pricing package, including premiums, deductibles and co-pays. Also, be sure the plan you’re considering covers all of the drugs you take with no restrictions.

Need Help

If you need some help with this or if you don’t have Internet access to compare drug plans, you can call Medicare at 800-633-4227 and they will do the comparing for you over the phone for free, and enroll you in a new plan when you’re ready.

Some other great resources that can help you are the Medicare Rights Center (medicarerights.org), a nonprofit consumer service organization that maintains a hotline at 800-333-4114 to help answer your Medicare questions. And, your State Health Insurance Assistance Program (SHIP), which provides free one-on-one Medicare counseling in person or over the phone. To find a local SHIP counselor visit shiptalk.org, or call 800-677-1116.

Shrinking Donut Hole

You also need to know that Medicare’s “donut-hole” coverage gap will shrink a little more next year. Thanks to health care reform, Medicare Part D beneficiaries that hit the coverage gap in 2012 will again receive a 50 percent discounts on brand-name drugs, and an increased 14 percent discount on generic medications.

For 2012, the coverage gap begins if your total drug cost exceeds $2,930 (that includes your share and the insurer’s share of the costs) and ends when your total costs reach $6,657.50. After that, your Part D plan usually covers around 95 percent of your remaining drug costs for the year.

If your income is under $16,335 a year (or $22,065 for married couples) and your assets are below $12,640 (or $25,260 for married couples), may be eligible for “Extra Help” in paying for their Medicare prescription drug coverage.

For more information call 800-772-1213 or visit www.ssa.gov/prescriptionhelp.

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