Changes since last year mean seniors should shop wisely, experts say
FRIDAY, Nov. 14 (HealthDay News) -- With the enrollment period for Medicare's Part D prescription drug coverage program for 2009 kicking off Nov. 15, experts are advising seniors to choose a plan carefully because premiums and covered medications can vary from plan to plan.
"As we enter the fourth year of the Medicare Part D prescription drug program, we continue to see high satisfaction rates among beneficiaries and high participation among plans," Kerry Weems, acting administrator of the U.S. Centers for Medicare and Medicaid Services, said in a statement.
"However, plans do change their offerings from year to year. Some beneficiaries may see significant premium increases or changes, such as reduced coverage in the gap, if they stay in the same prescription drug plan in 2009. We encourage individual beneficiaries to review how their plans are changing and what other options are available to them to determine which plan best meets their needs," Weems said.
Paul Precht, director for policy and communications at the Medicare Rights Center, echoed that advice. "Probably the higher premiums will get some folks to look at their coverage options," he said.
"It's going to be tough for people. The premium increases are substantial," Precht added. "People are also seeing increases in the co-payments -- it comes at a tough time."
Medicare prescription drug coverage, sometimes called Part D, is insurance for seniors and some disabled people that covers both brand-name and generic prescription drugs at participating pharmacies. Open enrollment for Part D runs until Dec. 31.
People who are satisfied with their current plan don't have to do anything to stay enrolled. But those in so-called standalone plans that only cover medications will see premiums increase by an average of $7.40 a month, from $29.89 in 2008 to $37.29 in 2009, according to Medicare officials.
Consumers should be smart when choosing a plan because premiums can vary widely, from $10.30 a month to as much as $136.80 a month. Most people should be able to find a plan in the lower premium range, according to the Kaiser Family Foundation.
Most Part D participants who don't qualify for a low-income subsidy and who don't switch plans will see an increase in their monthly premium, according to the foundation. Twenty-seven percent will see premium increases of at least $120 per year.
Premiums aren't the only consideration when choosing a plan. Another important issue is making sure the plan you choose covers the drugs you take. Covered drugs and restrictions on drugs vary from plan to plan, so it's important to review each plan before making a choice, Precht said.
One of the most serious issues in choosing a plan is the coverage gap, or so-called "doughnut hole." While in this gap in coverage, most Part D participants must pay 100 percent of their total drug costs. For most plans this will total $3,454 in 2009, according to the Kaiser Family Foundation.
In 2009, nearly all Part D plans have a coverage gap, but one in four plans offers limited coverage in the gap -- generally coverage for some or all generic drugs, though some plans also cover some or a few brand-name drugs, according to the foundation.
Considering the price of drugs in a plan is also important, Precht said. "There are a number of plans that charge quite a bit more for generics than other plans," he said. "Particularly for people who take multiple drugs, that can make a difference between getting in the doughnut hole or not getting in the doughnut hole."
Precht said some people use a combination of strategies to reduce their drug costs. "They rely on the cheap generics, if you can get it from some of the 'big box' stores, using Part D for brand name drugs, plus buying drugs from Canada as an option for brand-name medications," he said.
People in Part D who meet the requirements for the low-income subsidy usually aren't responsible for costs in the coverage gap. The gap was intentionally included in the plan when it was launched four years ago so costs would not exceed the limits set by Congress.
Another option for some people may be a so-called Medicare Advantage Plan. These plans cover both your medical care and prescription drugs. But before enrolling in one of these plans you may want to be sure your doctor and hospital are part of the plan you choose.
For more on Medicare Part D, visit the U.S. Centers for Medicare and Medicaid.
SOURCES: Paul Precht, director, Policy and Communications, Medicare Rights Center, New York City and Washington, D.C.; Kaiser Family Foundation
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