Medicare Part D Health Article

Medicare Part D: What You Need to Know

The six-week enrollment period for the Medicare prescription drug plan (Part D) is coming up soon - enrollment runs from November 15 through December 31, 2007 for the 2008 plans. Medicare's drug plans are subsidized by the US federal government and offered through private insurers. In January, 2006 Medicare enacted Part D as a supplemental insurance plan for seniors to offset the costs of prescription medications. Part D is an optional plan in which the insured (consumers) pay a premium each month and Medicare pays for prescriptions.

If you decide not to enroll in Part D when you're eligible, you may be charged a penalty for enrolling later. The initial enrollment period is the period three months before and three months after your 65th birthday. If you are disabled you may enroll three months before and three months after your 25th month of disability. This is called the Initial Enrollment Period. If you opt out of the Initial Enrollment Period and choose to enroll later, you may calculate your penalty by 1% of the national average premium for the year you choose to join and multiply it by the number of months you were eligible to join but didn't. If you currently have prescription drug benefits through another insurer, contact your insurer to see if you will benefit by enrolling in Medicare Part D.

Medicare Part D was enacted to protect seniors from increasing or unexpected drug costs. If you belong to a Medicare HMO or are on Medicare and Medicaid you may be automatically enrolled in a prescription drug plan. Check with your provider or call Medicare if you have any questions about your existing prescription drug coverage. Enrolling in a Part D plan may make sense for you if...

• Your income is less than $1200 a month
• You have coverage under Medigap
• Your medication expenses exceed $750 per year

To help consumers understand Medicare Part D, the Centers for Medicare and Medicaid Services has published a 116-page publication (available online by calling 1-800-633-4227) entitled Medicare & You 2008. If you have prescription drug coverage through your or your spouse's employer or union, check with your benefits administrator before enrolling in any Medicare Plans, as it may impact your existing coverage. If you have prescription benefits through the VA, Tricare or the Federal Employee Health Benefits Program (FEHBP) you may not need Part D, although if you choose to enroll, it could offset your costs and co-payments. A list of Medicare Part D prescription drug plans may be found here.

Plans are regional and it's important to compare Medicare drug plans offered in your area before enrolling. Check each plan's formulary (list of covered drugs) and their rules for filling prescriptions. Compare your list of prescriptions against monthly premiums, deductibles, copayments, and coinsurance and find out if the plans work with your pharmacy and if they offer medications through the mail. If you spend winters or summers away from home, find out if your plan will accommodate that.

Be aware of any additional rules such as prior authorization, limited quantities of refills, and step therapy, which requires that lower cost medications be tried first.

The premium for your Part D prescription plan can be deducted from your Social Security benefits or from a savings or checking account You can also choose to get a monthly bill in the mail. Medicare.gov has a Medicare Prescription Drug Plan Finder to help provide more information on plans in your local area. Review your options now, and enroll early to take advantage of your plan.

Because the program is new, expect changes to the plans over the next few years. A 2007 report from Consumers Union found that 28% of private insurance plans across the country increased their costs by 5% or more in 2006 - after Medicare beneficiaries were already enrolled in their plans. During the first calendar month of 2007, 95% of sampled plans increased their costs. You can track how your plan is performing for you each year by keeping tabs on:

• Your premium
• What you spend out-of-pocket for medications
• Which of your medications are not covered by your plan
• Changes in the costs of your medicines
• How well your plan's customer service can explain your coverage and answers your questions.
• Whether your expenses will put you into the donut hole, or coverage gap.

If the costs of your selected plan have been unpredictable consider switching your plan. Making an informed choice and comparison shopping is important since you won't be able to change plans until the next enrollment period.

You can use Healthline's Part D Plan Selector to find which plan might be right for you. Click here to learn more.