Medicare Part D

You still have time to add prescription drug coverage to your Medicare!

Open enrollment ends at the end of this month.

Until then, you can go on-line or call 1-800-MEDICARE to get help adding this to your Medicare Part A and B (these cover hospital and outpatient medical care).

Basically, these are commercial insurance plans that meet or exceed standards set by the federal government. They are used for covering the costs of you medications.

There are lots of choices, and lots of differences in cost. The last time I looked, there were over 50 plans in California and the average premium was about $45/month.

DO. NOT. PANIC.

First of all, if you have very little money (make less than $14,355/year yourself, or less than $19,245/year as a couple at last count) you may be entitled to Plan D at no cost to you at all as long as you pick a plan that does not exceed the average premium cost for California.

Second, use the available resources to narrow your search:

• You live in California. Only look for plans offered in California.
• Most generic drugs are not a real issue. The ones that aren't generic are the ones that will cost you (such as Actos and Avandia for diabetes, brand name insulins like Lantus and Humalog and ARB's for blood pressure and heart failure like Diovan, Cozaar and Atacand). Generate a list of your expensive drugs, and then look for plans that cover them.
• If you already have Part D and always end up having to pay full cost on you pills before the end of the calendar year, this does not mean that your insurance no longer covers it! This means you've hit the "donut hole" for the year.
• This means Part D has covered $2,250 for the year and that you are on the hook for the next $2,850. If you go past that for the year, then Part D picks up for the rest of the year.
• If this keeps happening to you, pay a bit more for a plan with "donut hole" coverage!

This link shows all the plans available for 2009 in El Dorado county in nice neat columns showing what they are called, how much they cost, whether they are free to low income folks and whether they have gap (donut hole) coverage or not.

It also provides links to the plans so you can see all the details, and toll-free numbers for folks who prefer telephoning.

Use it or lose it!

Medicare Drug Plan Open Enrollment

November 15th to December 31st is the open enrollment period for Medicare! Medicare Part D covers prescription costs, and can be added or changed during this period.

Please note that premiums may go up or down starting in 2008, so even if you are happy with your present Part D you should double-check whether the cost is going to go up and whether it is still going to cover your medicines. You can find out by calling 1-800-MEDICARE. This article in the Sacramento Bee discusses this.

While the drug benefit affects people differently depending upon their incomes, their health and where they live, the standard benefit looks like this: Participants pay the first $275 in drug costs. Then, the plan pays 75 percent of the tab until total drug costs reach $2,510. That's when beneficiaries hit the so-called doughnut hole, where they pick up all cost until they've paid $4,050 out of pocket. After that point, they only have to pay 5 percent of the tab for their medicine.

Medicare's website is a useful on-line resource.

This link is to the site's menu of the plans for 2008 in El Dorado County that have prescription drug coverage. Clicking on the names in the left column will give you details on each plan's benefits. It also allows you to filter or pick out plans based on other choices including dollar limits on the premiums.

This link is to the site's prescription drug portal. It includes ways to check out plans based on your list of medicines and by preferences including costs.

You can enroll in a plan here.

I hope this is helpful if you are looking into this for yourself, your spouse or your parents!

Also, remember that many medicines can be changed to suit your plan coverage with no sacrifice in quality of your care. Let us know if we can help you with this.