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Health Care Reform
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How to Best Prepare for Your Medicare Part D Decision?
| So now that everyone needs to wait yet a few more days until all of the prescription drug lists are available, you can use this "free time" to best prepare for your Medicare Part D enrollment decision. As we noted in an earlier Newsletter, there are a series of factors that you must consider when searching for the right Medicare Part D plan. We have expanded that earlier list with a few new items below: |
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A. Basic Consideration
- Are you already covered by a "creditable" prescription drug program?
- Do you have VA coverage? (see #4 below)
- Do you have coverage from your previous employer or union?
- Do you have any other plan that is as least as good as Medicare's basic drug plan coverage? (a good question for your existing plan's administrator)
- Can this other creditable prescription drug coverage be coordinated with the Medicare Part D program? (another good question for your existing plan's administrator)
- Determine your CMS region --the US is divided into 34 regions for purpose of Medicare Part D implementation -- for instance, Pennsylvania and West Virginia are in PDP Region 06. (The CMS website provides a nice PDP Region Map for your convenience.)
- Once you have your region, determine which plans are available in your area. (Please note: We will be providing a list of national Medicare Part D providers on our website with a comparison per region.) Please also take a look to the local Medicare Part D plans in your region and you may find that your nearby HMO or PPO can also provide you with the right plan.
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B. Your Deductible Preferences
- Are you comfortable with a $250 initial deductible?
- Would you prefer a plan with "first dollar coverage" or no initial $250 deductible? (note: You may pay a higher premium for a plan with "first dollar" coverage -- see "budget" below.)
- Would you prefer a plan with Donut Hole coverage? Some plans will be offering coverage to "close-up" the Donut Hole. These plans may have a higher monthly premium.
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C. Your Coverage Preferences -- What Would you prefer?
- Co-Insurance (the beneficiary pays a percentage of the drug costs -- for instance, 25% paid by the beneficiary and 75% paid by the plan provider)?
- Co-Payment (the beneficiary pays a fee per prescriptions and the prescription drugs are organized into cost tiers -- for instance, a co-pay schedule could look like $5/$25/$65 for tier 1/2/3 drugs)?
- A combination of co-payment or co-insurance?
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D. Prescription Drug Considerations
- Make a List of all prescription drugs, dosages / monthly quantity, and annual costs (you may wish to ask for help from your physician, nurse, or pharmacist).
- Are your prescription drugs on the plan's formulary (prescription drug list)? -- (note: this is probably the most difficult task.)
- If your prescription drugs are not on the formulary, are there alternative prescription drugs listed on the formulary that your physician can recommend?
- Do you prefer name-brand or generic prescription drugs?
- Are you looking for a plan with a Mail-Order option?
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E. Pharmacy ConsiderationsIs your favorite Pharmacy included within a plan's Pharmacy network? (Please note, a few Medicare Part D providers are still negotiating with pharmacies, so if your pharmacy is not included in your chosen plan's network, check back later and you may find the pharmacy added. It may also be possible to recommend a pharmacy directly to the provider for inclusion in the network.)
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F. Company / Provider ConsiderationsDo you have a preferred provider or an insurance company with whom you have an established working relationship? |
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G. Budget Considerations
- Calculate your annual prescription drug costs with and without a Medicare Part D program (also not an easy task -- we mentioned in an earlier Newsletter that annual out of pocket costs of over $810 dollars could mean that a Medicare Part D plan makes sense for you if your monthly premium is less than $32 per month).
- Calculate your estimated annual Medicare Part D plan premiums -- Can you comfortably afford the plan's premiums along with the co-payment or co-insurance payments?
- Are you financially eligible for an "extra help" program?
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