Picking a Medicare Drug Plan – Using the Medicare Prescription Drug Plan Finder! Medicare drug benefit enrollment is here! Beginning November 15th, Medicare beneficiaries could sign up for a drug plan – which for many kidney patients with Medicare will sharply cut drug costs. Benefits first become available January 1st. To recap our earlier reports, Medicare drug plans will be offered by private health insurance companies – and in most States, Medicare members will have 40 or more choices! Plans will differ in “cost sharing” – that is, monthly premiums, deductible, co-payments for each prescription, and whether there is a “donut hole” or coverage gap (where you pay for all drugs costs out of pocket – like a second deductible) – and what drugs are included on the plan formulary (list of covered drugs). You can download the list of drug plans in your State from Medicare’s Web site, by clicking here. Note “stand alone” plans are for people in regular Medicare, which includes most kidney patients. If you are enrolled in a Medicare health plan (also called “Medicare Advantage”), your plan will send information about that plan’s drug options.) Wow, 40+ choices! How to pick a good plan – a plan that provides you with the best drug coverage and lowest TOTAL cost? First, we repeat advice in November’s issues of aakpRENALIFE: Having many drug plan choices may sound challenging – so AAKP encourages everyone to relax and take a deep breath! You may hear some people with Medicare find the drug plan choices confusing. WE SAY – SO WHAT? Picking a drug plan is too important to most kidney patients to be put off by the modest work it will take to pick a plan! So, where to start? Medicare recently posted a new tool on its Web site to help you pick a plan, called “Medicare Prescription Drug Plan Finder.” (Or you can call 1-800-MEDICARE, and a Medicare customer service representative will perform drug plan searches for you.) The Drug Plan Finder compares: - Cost: The Drug Plan Finder will show you a list of drug plans in your area, sorted by the plan with the lowest total cost for the drugs you take now.
- Coverage: The Drug Plan Finder will make it easier for you to see what kind of drug coverage each plan offers.
- Convenience: The Drug Plan Finder can identify plans accepted by your local drugstores, and plans that provide mail-order prescriptions.
Here are key steps in performing drug plan searches using the Drug Plan Finder (for either you or a family member): 1. Have your Medicare Card ready, which includes personal information needed to make a custom drug plan search: Medicare claim number, date of birth, effective date for Medicare part A or B, and ZIP code. (You can perform a “general search” without this information.) 2. Prepare a list of all your prescription drugs – with dosage and how often refills are made (e.g., monthly). You might check with your doctor to find out if there are alternatives to your drugs that may be less costly, such as generics or other brands. 3. Next, go to the Medicare Web site, and click on “Compare Medicare Prescription Drug Plans.” You can choose either “A. Personalized Plan Search,” or “B. General Plan Search.” 4. You will be asked if you have “Current Prescription Drug Coverage,” and whether you are “Eligible or Qualify for Additional Help.” The July issue of aakpRENALIFE describes extra financial help – which may pay for your drug plan premiums and other cost sharing. Read about “extra help” online. Click here. 5. Next, pick a drug plan type. Choose between “B. Medicare Advantage Plans and Other Medicare Health Plans,” or “C. Medicare Prescription Drug Plans.” Most kidney patients will pick “C. Medicare Prescription Drug Plans.” 6. Click, “Search for Medicare Prescription Drug Plans.” The next Web page will allow you to “Enter your medications,” and “Limit your drug plans” based on cost. At this point, enter one of your medications (and repeat this step as many times as needed to enter all your medications). You should enter dosage information as well. To see all your drug plan choices, you may not want to limit your drug plans. 7. You may select a preferred pharmacy. Again, to avoid limiting plan selection, you might not want to run this step. 8. Click “Continue to plan list,” which will bring up your plans choices, with least costly plans first. You can also select up to three plans to compare side-by-side. You can re-run the Drug Plan Finder as many times as you want – for example, to try how alternative medications might affect your total cost. 9. After you are sure a plan includes your drugs, you should carefully check whether there are formulary “restrictions” on your drugs that are an issue for you – such as pre-approval by a plan before a prescription can be filled, or if “step therapy” is required, where another drug may have to be tried first before the drug will be covered. One word of caution, when we have run the Drug Plan Finder, we have found we need to double check the total cost and coverage carefully. For example, we found that the actual prescribed amount differed from the choices the Drug Plan Finder offered – which lowered our cost and that recommended another plan. Generally, the information appears to be accurate, but again, before signing up for any plan, you should confirm important information with the plan sponsor – including that all your drugs are included on the plan formulary and what your TOTAL cost will be. One last piece of advice – don’t let the “perfect” be the enemy of the “good.” You certainly want a plan well suited for your drug needs and is the best value. But no plan will be “perfect” – which shouldn’t discourage you from signing up. Twenty-eight years ago, in 1972, many ESRD patients faced a life-and-death crisis because insurance rarely covered dialysis. That year, Congress passed Medicare coverage for people with ESRD, a lifesaving miracle. In 2003, Congress created a Medicare drug benefit for the first time – which given the importance of drugs to most kidney patients – might just be a second miracle. This article originally appeared in the January 2006 issue of aakpRENALIFE, Vol. 21, No. 4.
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