Medicare Part D open enrollment: Time to look into prescription plans–even if you like your current one

by James Hubbard, M.D., M.P.H.

Do you understand Medicare Part D? Do you even know what it is? How about your elderly loved ones?

Medicare open enrollment starts November 15 and ends December 31. During this time every year, Medicare participants can change or tweak their Medicare Part D (prescription drug) plan.  Start early so everything is in place by the time the new coverage kicks in on January 1.

If you’re under Medicare age, consider helping loved ones with their decision.  There are several options and it can get complicated.

Here’s some help to get you started.


What if I don’t want to change?

Even if you like your current plan, gerontologist Esther Koch, founder of baby-boomer advisory group Encore Management, says you may not like it in 2009. “What few seniors or caregivers know is that these insurance companies submit new plans to Medicare each year.”  Prices and drug coverage can change, she says in a press release.


Where do I begin?

Go to the official Medicare government site to start, but the commercial site at medicare.com has some good decision tools to ward off ”analysis paralysis.”  Medicare Part D is the drug coverage, and you are not automatically covered. You have to enroll in a program to get the benefit.


How does Medicare Part D work?

You may have heard about all the Part D plans. A press release from The Center for Medicine in the Public Interest explains:

Part D is … administered by private insurance companies. In other words, taxpayer dollars operate as a subsidy, but then seniors are allowed to select the drug benefit that best suits their needs.

But forget the array of plans available; the basic coverage itself is complicated enough.  I think I figured it out with medicare.com’s help.

  1. You have an initial $295 deductible.
  2. If you meet that, Medicare pays 75 percent of drug costs (you pay 25 percent) until you reach $2,700.
  3. At that point, you have a second deductible and have to pay all costs until you get to $4,350.
  4. Costs to you after that are very low–a few dollars per prescription–that is, until January 1 each year, when the deductibles start all over again.  Whew.  Leave it to the government.

Despite the confusion, it is worth your while to protect against catastrophic illness and costs that could wipe out your savings.  Those drugs can get pretty expensive.

So, I’m not perfect :)   Please help a doc by correcting any mistakes you find on my explaining the coverage.
I would also love your opinion, or experience with this Medicare Part D coverage.

 

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One Response to “Medicare Part D open enrollment: Time to look into prescription plans–even if you like your current one”

  1. James Hubbard’s My Family Doctor Blog » Blog Archive » Universal health-care debate: why vs. costs Says:

    [...] insurance, Medicare (for those over 65) and Medicaid (for the poor).  The Bush Administration expanded Medicare to include drug coverage.  Why not just expand the current programs to include everyone?  A single-payer, national [...]

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