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Research Medicare Part D options

Seniors need to review their options now to be aware of changes for 2010, including premium increases, new deductibles and alterations in the Extra Help program.

November 23, 2009|By Francesca Lunzer Kritz

Got your eye on the calendar? Good. Seniors who want to participate in the Medicare drug program, known as Medicare Part D, must sign up for coverage with a plan that serves their geographic region by Dec. 31. Sign-up began Nov. 15.

Once members choose a plan, they generally pay a monthly premium and annual deductible, plus a share of the cost of each drug. The plan sets the drug price and that price is paid to a retail, mail-order or online pharmacy -- it's the buyer's choice.

People who are happy with their 2009 plan should nonetheless review their options for 2010 because many plans change their costs and benefits from year to year, says Paul Precht, head of communications and policy at the Medicare Rights Center, an advocacy group based in New York City and Washington, D.C.

Many Part D plans that offered good deals for five commonly used drugs in 2006 increased their prices -- between 100% and 120% on average -- over the next three years, a June 2009 survey of plans in five states found. It's possible some plans entice new members with initial low prices and then count on inertia to prevent members from reviewing those costs when the prices are increased, says Bill Vaughan, a policy analyst at Consumers Union.

Here are some changes consumers can expect in 2010, Precht says:

* Average premiums will rise from $35 to nearly $39 per month.

* About 60% of plans will charge a deductible, up 15% from 2009.

* Fewer plans will offer coverage in the "doughnut hole," a gap in drug coverage in which consumers pay the full price for their prescriptions.

* More than 2 million people enrolled in Extra Help, a federal program that helps low-income people pay for some or most of the costs of prescription drug coverage, may face a premium of about $10 if they don't switch to a plan that qualifies for a full premium subsidy.

* More than 1 million people enrolled in Extra Help will be randomly reassigned for 2010 to a new plan that may impose different restrictions on their drugs. So it's important to check those plans for coverage specifics and seek assistance to change to a more favorable plan if needed.

The easiest way to compare plans is to log onto Medicare's website, www.medicare.gov; click "compare plans" in the middle of the home page. Or you can call Medicare at (800) 633-4227.

The Medicare Rights Center, www.medicarerights.org, also offers online information as well as toll-free operator assistance Monday to Friday at (800) 333-4114.

Precht suggests making a list of the medicines you take, the dosages and the cost you currently pay, as well as the pharmacies you use. With each plan you consider, find out whether all of your medications would be covered and, if not, whether a substitute acceptable to your doctor would be available.

According to the Medicare Rights Center, other questions to ask to determine your out-of-pocket costs include:

* Does the plan require special permission from your physician before it will cover the medication?

* How much will the drug co-payment or co-insurance be?

* Is there a monthly premium and annual deductible and what are their costs?

* Will you have to pay the full cost of your drugs at some point after the deductible (known as the doughnut hole or coverage gap)?

Don't just check the out-of-pocket price for a drug; figure out the plan's total charges for it. Here's why: Medicare adds up the plan's costs and the beneficiary's costs to determine how much has been spent on medicines. If you and the plan together spend $2,830 or more (up from $2,700 last year), you'll find yourself in the so-called doughnut hole, paying the full cost of your medications until your out-of-pocket expenses reach $4,550, up from $4,350 in 2009. If your plan pays more than average prices, you could find yourself in the doughnut hole sooner than you expected, says Joseph Baker, president of the Medicare Rights Center.

* Could you qualify for free drugs or some assistance in paying for your drugs for the Part D plan? Here's the basic eligibility information:

Your income must be limited to $16,245 for an individual ($21,855 for a married couple living together).

Even if your annual income is higher, you still may be able to get some help with your monthly premiums, annual deductibles and prescription co-payments if you support other family members who live with you; your resources are limited to $12,510 for an individual ($25,010 for a married couple living together). Resources include such things as bank accounts, stocks and bonds, but not houses and cars.

You can apply for Extra Help online ( www.ssa.gov/prescriptionhelp), by calling Social Security at (800) 772-1213 or by visiting a local Social Security field office ( www.socialsecurity.gov /locator).

health@latimes.com

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