Understanding and Selecting a
Medicare Prescription Drug Plan

by Lee Alexander

Medicare recipients and especially those eligible for the Medicare Prescription Drug Plan should definitely read the government handbook, Medicare & You, 2006. Its subtitle, “This year it's different” has real meaning. If you are like most seniors, myself included, you quickly scan the first few pages to see what is new in the coming year. After a quick check for the increases in Part B premium and (of late) the deductible, then its up on a shelf until the next issue arrives the following year. I believe you will want to keep this publication closer to hand.

Timeline: The first opportunity to enroll in the Medicare Prescription Drug Plan was November 15, 2005. Deadline for non-penalty enrollment is May 15, 2006.

Eligibility: as with the Original Medicare Plan, the period is three months before and three months after the month in which you turn 65.

Penalty = 1% added to premium for each month after May 15. As this is an insurance plan, the penalty of 1% per month is for life (or as long as you remain in the Prescription Drug Plan).

Waiver of Penalty: if you pass on enrollment because your employer (or former employee or union or other organization) covers you with creditable prescription drug coverage (a plan that, on average, is at least as good as the Medicare standard prescription drug coverage), and, at a later date, the company drops your coverage, you have 63 days from the end of the coverage to join a Medicare drug plan without penalty. Any letter from the company or union stating that their plan is as good as or better than Medicare's Prescription Drug Plan should be filed with your important papers.

The normal enrollment period is from November 15 to December 31 of each year. However, if you fail to enroll in 2006 while eligible, you may face a penalty from then on.

Plans may have a maximum (by law) of $250 deductible to zero deductible. The zero deductible plans usually carry a higher monthly premium.

The "doughnut hole" - is a benefit gap. After you have spent $250 (if the plan has that deductible), you co-pay for your prescriptions up to $2250 in costs. You then pay 100% of your drug costs for the next $2850. Thereafter, you pay 5% of your drug costs (or small co-pay) for the balance of the year. When you reach $3600 out-of-pocket, your plan pays the rest. This is the catastrophic phase of the insurance plan. On the Web sites you can see the details for your particular circumstances.

Begin by using the Internet to enroll (or just see the plans available in your area) in a Medicare Prescription Drug Plan.

Go to www.accesstobenefits.org/oe (organizational edition). Why use this site as a portal? The Federal government will credit the state for visits in the form of support for state agencies that assist in senior health education. This site is secure.

Your first step is to select a state from the drop-down list. For North Carolina , use the member name: ncshiip (North Carolina Senior Health Insurance Information Program) and the password 123456. At this point, unless you are just curious about what is offered, skip the questionnaire section, scroll down to Enrollment, and click on the third item, Medicare Prescription Drug Plan Finder. This will launch the Medicare homepage www.medicare.gov. This site is not secure, but as you step through subsequent pages (links) to “Find a Medicare Prescription Drug Plan,” it becomes secure. (tip: Look for https:// and a closed padlock near bottom right of the page when it is time to enter personal data on any page claiming to be secure.)

You should now be linked to the Medicare Prescription Drug Plan Finder. Scroll down to "Where would you like to begin?" And click the first item Find a Medicare Prescription Drug Plan. This takes you to another secure page where you begin to enter data. This would be a good time to hit F11 and toggle to Full Screen View, hiding the unneeded header of your browser. Now scroll down to see two choices:

A. Personalized plan search - entering the information from your Medicare Health Insurance card gives you information or your stat us     OR     

B. General Plan Search  (recommended).

Enter your zip code.

In section B, most will check “None of the above.”

C. You must select one of the buttons, Yes or No (if Yes, answer the other questions).

Now hit the CONTINUE button, which takes you to a new page. Here you will find the number of plans available and choose the drug plan type: Search for Medicare Advantage Plans, or Search for Medicare Prescription Drug Plans—Choose the latter.

We get a new page with three areas:

View Plan List, New Search, Enter my medications (it is recommended to jump and click on this button)

Limit your drug plans.

Start entering your Medications one at a time in box where indicated.

Tip: By default, the checkbox "use generic …" is enabled. If you cannot use a generic, it is vital that you uncheck the option and examine it repeatedly to make sure it is not enabled for the drug in question.

Demonstrating this at the club meeting, I entered a fictitious list of drugs to illustrate the "doughnut hole" in the plans. Hitting Continue with Selected Drugs, takes you to new page where you can change the drug dosage and quantity. When you are satisfied with your personal medications' specifics, hit Continue with Selected Drugs . A new page will give you the opportunity to choose a Preferred Pharmacy. (Note: there are 5 pharmacies in Franklin at the present time.) If you wish to find the best price locally, pass on selecting a preferred pharmacy, hit Continue to Planned List. This will take you to a new page showing plans available and their details, arranged in the order of least expensive annual cost.

You can also select an option to show three of the plans side-by-side. Note the column More About This Plan – (select option to view): On each plan is Select Below button; be sure to review cost in this area. Minimize your screen before opening the next site listed below.

Next, open the web site formularyfinder.medicare.gov; where you can check that all your medications are in the plan's formulary. For example, entering Fosamax found 56 plans in North Carolina. Adding the drug, Concerta, reduced the list to 32 plans. These are in alphabetical order. Click on the name of the plans from your earlier search and look at the Limitation/Restrictions (Prior Authorization, Quantity Limits, and Step Therapy). The Formulary Finder: Plan Formulary Stat us also indicates the drug TIER and if a drug is not on the formulary. If a drug is not in the Formulary, you pay the full amount for the drug, and it does not count towards your out-of-pocket expense.

Enrollment: After you have compared and checked out possible plans, you are now ready to enroll in the plan of your choice. Return to the page labeled Prescription Drug Plan Comparison, and click on enroll button. Just fill in the blanks. You have the option to have your premium deducted from your Social Security Check.

Print the confirmation page: ENROLLMENT SUCCESSFUL which lists the name of your plan, confirmation number (a long number) and plan's address and telephone number. This is information you take to your pharmacy when you need more medications. And, your Plan will mail you a card in the near future. The plan will start after Medicare has processed enrollment information. Your Plan probably will start the following month after your enrollment, depending on what time of the month you enrolled. In some situations, you many need to save pharmacy receipts on prescription drug purchases for reimbursement from your plan.

RESOURCES:

Seniors' Health Insurance Information Program (SHIIP)
1-800-443-9354 (this is the number on the inside back cover of the publication, Medicare and You 2006)

Local Contact for SHIIP Counselors: Macon County DSS—Diane Holbrook (349-2114)

Medicare Beneficiary Help Line 1-800-633-4227