Medicare Part D

Medicare D Plans-Now is the Time to review yours!

If you are like thousands of seniors across the country with a Medicare D plan, now is the time to take a look at your medications. You may need to make changes to your plan. Annual open enrollment only runs from November 15 to December 31 of each year. Any changes you make now become effective on January 1, 2009. Be sure to enroll or make changes early to ensure the least troublesome transition.

Even if you have been enrolled in a Part D plan in the past, you can't assume that the plan will continue to provide you with the same coverage. Each plan has a "formulary," a list of prescription drugs provided by that plan. The list of drugs can change from year to year, plus the cost of those drugs can also change annually. You need to evaluate your plan every year for plan changes as well as changes to YOUR medications.

If you have supplemental health and prescription coverage from a former employer, you should have already received a letter from the plan administrator indicating whether you have "creditable coverage" that is as least as good (or better) than standard Medicare D plans. You are often best off by keeping your existing coverage. However, if you are considering a change, be aware that terminating the prescription plan to switch to another Medicare D plan may cause you to lose your supplemental health insurance coverage as well. Also, if your employer based plan is terminated, as long as you have creditable coverage, you can switch to another Medicare D plan within 63 days without paying a late-enrollment fee even if it isn't between November 15 and December 31.

It is very difficult to choose the right prescription plan from the myriad of plans available. For example, in Ohio there are 49 plans to choose from. More than three-quarters of these plans are raising rates in 2009 for comparable coverage. Every plan has a different formulary, deductible amount and co-pay. Most plans have a gap in coverage known as the "doughnut hole," where plan benefits stop when plan payments have reached $2,700. The enrollee has to pay up to $4350 of his or her own money on covered prescriptions before benefits are again available (at only 5% of the cost of the needed drugs).

You have several choices when it comes to prescription coverage. First, you can stick with an employer's plan. Second, if you already have Medicare B, then you can enroll in a Medicare D prescription drug plan. Medicare B premiums for most people will be $96.40 per month in 2009. The Medicare D plans have a premium ranging from $50.10 to $97.50 per month. Third, you may want to consider a Medicare Advantage plan that includes supplemental health insurance along with extras like vision care, dental coverage and prescription coverage. Medicare Advantage plans range from $0 to $175 monthly. Additionally, if you are receiving Medicare AND Medicaid (you are a dual-eligible), then your prescription plan must be a traditional Medicare D plan. Some employer based and other prescription reimbursement plans will not work for dual-eligibles because Medicaid will not coordinate benefits so that any co-pays or deductibles not covered by the prescription plan are picked up by Medicaid.

This is such a large and complicated decision that you may want to get some help. Advice is available from local Area Agencies on Aging, from state health insurance information programs or by calling Medicare's toll-free number or visiting their website. Also, once you decide on a plan, be sure to speak to a company representative to verify the coverage and cost. Finally, we would be happy to assist you in your decision making.