Buyer beware with new Medicare drug plans

Published 12:00 am Tuesday, November 29, 2005

Do not rush into a Medicare Prescription Plan. You have to do your homework and research.

You have until May 15 to make a decision before a premium penalty is administered. There are big differences in premiums and deductibles, the drugs they cover, the copays they charge and the pharmacies they use. Those differences are important to know when choosing a plan.

Under the standard benefit (the minimum set by law) for the calendar year 2006, you would pay:

uA premium of about $32 a month (in addition to the Part B premium of $88.50 a month in 2006).

uA $250 annual deductible on drug costs before coverage begins.

u$500 (or 25 percent) out of the next $2,000 of drug costs. Your plan pays the remaining $1,500 (or 75 percent) in the initial coverage period

u$2,850 (100 percent) of additional drug costs. Your plan pays nothing in the coverage gap, also known as the &8220;doughnut hole.&8221;

uAbout 5 percent of all remaining drug costs in the year once you have spent $3,600. Your plan pays 95 percent at this &8220;catastrophic&8221; level of coverage.

In Alabama, 17 companies are offering a variety of drug plans with a total of 41 plan choices.

These plans vary in monthly premiums as low as $21.90 with First Health Premier to $69.98 with Prescription Pathway Platinum.

Deductibles range from $0 to $250. Copays range from $0 to $60; but beware, some plans have a percentage of copay costs up to 45 percent of the drug cost. Of the top 100 drugs, the plans covered from only 74 to 99 of these drugs.

This is the reason you must shop to fit your needs. To determine exact costs and benefits, compare plans.

Where do I start my homework? The first step is to make a list of your drugs to include the drug name, dosage, frequency of taking, and the cost (The full cost of the drug).

You are now ready to discuss costs with providers.

Also ask what pharmacies carry the plan. If the pharmacy is not convenient you may want to consider another plan. Under most plans you should be able to get a 90 day supply.

Talk to your doctor and pharmacist to find out if there are generic drugs in your formulary to help control costs.

There may not be a generic drug for the drug you are taking. Remember, you must use one of the pharmacies within your plan&8217;s network.

Going out of network will likely cost more. Your plans must offer pharmacies within a reasonable distance from you home. Many plans will also offer mail order service.

If you are not pleased with you plan, you will have at least two opportunities to switch plans before May 15, 2006.

After that, you can normally change plans only once a year, between Nov. 15 and Dec. 31 (Open Enrollment Period).

There are exceptions. For example, if you move out of your plan&8217;s area or into a nursing home, or your plan ceases services in your area you can make changes.

If you live in a different state during a year, a national plan would cover you throughout the United States.


your plan offers mail-order services, your drugs could be sent to a temporary address, but make sure the plan allows that option.

Dr. Marvin Copes serves as a volunteer for AARP. He can be reached at