Comparing and choosing coverage
Open enrollment for 2014 is underway. And these charts can help you compare the premiums, deductibles and drug coverage offered in your community. You must make your final choice by Dec. 7.
One chart details the 30 plans in Florida covering only prescription drugs. These options, called Part D or stand-alone plans, have the same benefits statewide. They usually appeal to seniors who want to stay on traditional Medicare, which does not offer drug coverage. These plans also can help those who have medical coverage from a former employer or government agency that doesn’t include prescriptions.
Seniors with Part D coverage pay additional premiums for those plans as well as their Part B Medicare premium, which covers such services as doctor visits and outpatient therapies. Part B is deducted from Social Security checks. The 2014 Part B premium hasn’t been released yet, due to the government shutdown. It was $99.90 to $319.70 a monththisyear, dependingona person’s income.
The other charts show the man- aged care Medicare Advantage plans offered by private insurers. The majority include prescription coverage, but not all. Many also have attractive additional perks, such as gym memberships, transportation to doctors or monthly stipends for pharmaceutical supplies. But be aware, experts say, that these splashy add-ons shouldn’t be your main focus.
Managed care plans’ appeal is that they usually offer more benefits and lower co-pays than Medicare. In fact, federal rules require all Advantage plans to provide at least the same level of coverage as traditional Medicare.
However, most of these plans are true HMOs, or health maintenance organizations, limiting participants to network doctors, pharmacies and healthcare facilities. A few South Florida plans are preferred provider organizations, or PPOs. They allow more provider choice, don’t require referrals and may pay for some outof-network services. But they come at a higher price.
Most South Florida Medicare Advantage plans take the Part B pre- mium as payment but do not ask seniors to pay more. A few even pay a portion of plan participant’s Part B. But a few others, particularly PPOs, require additional monthly premiums.
Private fee-for- service plans (PFFS) allow you to go anywhere. Butmakesureyourdoctorsandhospitals accept these plans before enrolling. There also are very few PFFS plans in Florida.
Advantage plans are not standardized. Drug and doctors co-payments, hospital coverage and other benefits can be different from countytocounty, evenif the planhas the same name statewide.
Special needs plans, or SNPs, offer even lower-cost alternatives for those onlimited incomes, those who are dually enrolled in Medicare and Medicaid, or who have chronic or disabling health conditions like diabetes or pulmonary disease. There also are SNPs for nursing homeresidents or people receiving long-term care service in other settings.
All plans with a drug benefit will offer what’s called “catastrophic coverage” after you have paid $4,550 out of pocket in 2014. You will then pay $2.55 for generics with a retail price under $51 and 5 percent for those priced higher. For brands, you’ll pay $6.35 for drugs with a retail price under $127 and 5 percent for those priced higher.
Drug co-pays in this guide are based on a 30-day supply at an innetwork retail pharmacy. Mail-order prices may be lower; out-of-network costs may be higher.
Other numbers are based on using in-network doctors, hospitals and providers.
Eye and vision coverage is for routine wellness or supplemental exams, not doctor visits or other services. Some plans offer additional dental, hearing and vision services with no or small co-payment, or additional premiums.
Plandetails arethemost currentavailableatthetimeof publication and can change. Symbols: * Total costs determined by adding your deductible, co-pays and the plan’s pay-outs for your drugs.
** Plan benefits in the coverage gap, also called the “doughnut hole.” In 2014, Medicare requires you receive a 28percent discount onyour generics and 52.5 percent discount on other medications in the gap. You exit the gapin2014whenyouhavespent$4,550onyourdrugsoryouandyourplan together have spent a total of $6,455, including credits for the discounts.
*** Stars range from 1 to 5, with 5 being the best. Medicare ratings are based on member satisfaction surveys, preventive care offered, customer service and other factors.
**** If you are low income, you have no premium in these prescription plans. In other plans, you pay discounted premiums.
***** Plandetails werenotincludedonMedicare.govbutmaybeonthe insurer’s web site. Call plan to check.
! Medicare has given this plan a low rating, below three stars, for three consecutive years. Online enrollment has been disabled for these lowperforming plans.