Planning ahead

Shop smart for Part D drug plan

Nearly 90% of people enrolled in Medicare don’t take advantage of the opportunity to make changes to their health coverage without paying a penalty during the program’s annual open enrollment period of Oct. 15 to Dec. 7.

In fact, only about one in 10 of the 58 million current Medicare beneficiaries opt to switch up their coverage, according to the Henry J. Kaiser Family Foundation, a non-profit organization that analyzes health policy.

The downside of not taking action during open enrollment is that Medicare beneficiaries miss the chance to not only find a plan that better fits their needs, but also the opportunity to save some money, cautions Leslie Fried, senior director of the Center for Benefits Access at the National Council on Aging.

This is especially true of the Part D prescription drug plans, which anyone enrolled in a traditional Medicare policy (approximately two-thirds of all beneficiaries) needs to have.

To streamline the process of picking a plan, Fried recommends seniors focus on answering the following three questions when considering which Part D program to choose:

1. Does the drug plan in question cover your prescriptions?

2. What will your out-of-pocket costs be?

3. Can you fill prescriptions at your preferred pharmacy?

The rates for next year’s premiums for Part D plans have yet to be announced.

But according to Fred Riccardi, director of client services for the Medicare Rights Center, a non-profit that helps people access affordable health care, “The Medicare Trustees are predicting in 2018 that the standard Part D premium will be stable and could remain at $134 per month.”

Still, he doesn’t advise people pick a plan based solely on their monthly payment.

“Some people tend to be primarily concerned about the premium and the deductible, but the actual cost of the medication and its coverage — whether it’s covered or not — is really important,” he says.

Seniors should take the time to compare the costs of medication across different plans “because it can vary widely,” Riccardi adds.

“Knowing whether there’s prior authorization or a quantity limit, and understanding how much the medication would cost throughout the year — since there are different phases of cost depending how expensive the medication may be — are also important.”

The reason that knowing how much you’re owed from your prescriptions is so helpful is because every Part D drug plan has something called an initial coverage limit, also known as a donut hole.

Next year, once a beneficiary and his or her insurance company have paid a combined $3,750 for prescription drugs, they’ll fall into this gap, at which point the health care provider is no longer responsible for covering drug costs.

Instead, the beneficiary shares the cost of expenses, up to $5,000, with the company that manufactured their medications.

“With the donut hole, there’ll be a 65% pharmaceutical manufacturer discount on brandname drugs for folks who end up in the coverage gap in 2018,” Riccardi says. “Then, the beneficiary is responsible for 35%.”

So if it costs $100 to fill a prescription, the out-of-pocket costs for the insured would be $35.

“For generics in 2018, the consumer would be responsible for 44% in the donut hole,” says Riccardi.

The easiest way to compare Part D prescription drug plans is by going online to medicare. gov and using its plan finder; calling the Medicare helpline at 800-Medicare; or receiving in-person assistance from a State Health Insurance Assistance Program (SHIP), which is known as HIICAP (the Health Insurance Information, Counseling and Assistance Program) in New York State.

For more information on HIICAP, visit aging.ny.gov or call 800-701-0501.