The Medicare Rights Center, a national consumer advocacy group, is reminding all people with Medicare that they have until December 31 to change their Medicare health and drug coverage options without restriction. After January 1, most people will be allowed to change only their choice of Medicare health coverage, and only once.
"The time to choose your Medicare private drug plan for 2010 is now," said Joe Baker, president of the Medicare Rights Center. The group recommends that everyone with Medicare review all of their options, even if they are happy with their current drug plan.
"Our hotline counselors have been particularly busy this past month," said Baker. "Rising premiums is the number one complaint among callers. Other consumers are concerned about coverage during the doughnut hole, the gap in coverage when people must pay full price for their medications. Still others are calling because their plan or retiree coverage is being cancelled. And we have had calls from people with limited incomes who have learned that their plan will no longer qualify for a full premium subsidy in 2010."
How To Choose the Part D Plan (either a stand-alone drug plan or a drug plan that is part of a Medicare private health plan) That Best Meets Your Needs
First:
- Make a list of the medicines you take, the dosages and how much you currently pay.
- Make a list of pharmacies you use regularly.
Then decide what type of drug plan you need. If you have:
- Original Medicare: Choose a stand-alone prescription drug plan (PDP) if you want to continue to receive your other health benefits through Original Medicare.
- A Medicare private health plan (such as an HMO or PPO): Generally, you must get Part D drug coverage as part of your private health plan's benefits package.
Third, use the Medicare Drug Plan Finder tool at http://www.medicare.gov or call 1-800-MEDICARE to review your options and get details. Fourth, ask questions, such as:
- Does the plan cover all the medications I am taking?
- If the plan does not cover a medication I take, does it cover one that will work for me? (Ask your doctor.)
- Does the plan require that I get special permission before it will cover the medication I need (such as prior authorization or step therapy)?
- How much will I pay at the pharmacy (copayments or coinsurance) for each drug I need? (Be aware that certain drugs may cost a lot even if they are covered.)
- How much will I pay in monthly premiums and annual deductible?
- Will I have to pay the full cost of my drugs at some point after the deductible (coverage gap)?
For a list that includes these and more questions to ask, go to Medicare Interactive
The Medicare Rights Center urges people to consider the following questions before enrolling in a Medicare private health plan (like a Medicare HMO):
- Will I be able to use my doctors? Are they in the plan's network and are they taking new patients who have this plan?
- Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan's network?
- How much is my monthly premium?
- How much will it cost to see my primary care physician? A specialist?
- Do I need a referral to see a specialist?
- Are my prescription drugs on the plan's formulary (list of covered drugs)?
- Does the plan require that I get "prior authorization" before my prescription will be covered, or impose other restrictions (like limiting the quantity or requiring that I try a cheaper medication before it will cover a more expensive one)?
- How much will I have to pay out of pocket before coverage starts (what is the deductible)?
- How much will I pay for brand-name drugs? How much for generic drugs?
- Are there higher copays for certain types of care, such as hospital stays or cancer treatment?
- Does the plan have an annual limit on out-of-pocket costs? Do all services count toward the out-of-pocket maximum?
- What service area does the plan cover?
- What kind of coverage do I have if I travel outside of the service area?
For a list that includes these and more questions to ask, go to Medicare Interactive.
The Medicare Rights Center offers the following resources, at no charge, to help people choose a stand-alone drug plan or Medicare private health plan that best meets their needs.
Medicare Interactive
This free, web-based counseling tool provides consumer-friendly information about Medicare benefits, rights and options.
Telephone Counseling
Consumers who prefer to speak with a counselor can call the Medicare Rights Center's toll-free hotline at 1-800-333-4114. Counselors are available Monday through Friday, 9:00 am to 5:00 pm (Eastern Time).
Source
Medicare Rights Center
