Saturday, March 04, 2006

Medicare Part D - the solution

I had posted a few days ago about how I was helping my mom decide whether or not to enroll in the Federal government’s new Medicare Part D plan for Prescription Drug Coverage. I mentioned that it looked complicated, but actually, once you sink your teeth into it and really begin researching the options, it’s not that bad.

My mom currently has typical Medicare coverage; both Part A and Part B. She pays nothing for Part A (as normal) but does pay the Part B premium (which is now about $88/month). In addition, she’s also enrolled in a Medigap program; Blue Cross and Blue Shield of Arkansas Plan D (Medi-Pak D). These two plans, together, would cover most of her medical expenses should she become ill, but they do NOT cover prescription drugs. After doing some initial investigation, I determined that she has three basic options;

1) Keep things just the same as they are now. She would continue to pay for her prescription medication (eye drops), and her Medicare Part B and Medigap premiums.

2) Keep her Medicare Part A&B and Medigap insurance and also enroll in a Prescription Drug program to help pay for her prescription medication.

3) Drop her Medigap coverage and enroll in a Medicare Advantage program (with or without a Prescription Drug coverage option).

The third option, enrolling in a Medicare Advantage program, is the most radical and, after some discussion, was one we discarded. This option would, essentially, change her current Medigap-type coverage to whatever benefits were offered by the Medicare Advantage program she enrolled in. The premiums for these Medicare Advantage programs are generally cheaper than the ones charged for Medigap coverage, but money isn’t the only concern here. My dad had cancer and eventually succumbed to it, but it was not for lack of medical care. He had excellent care and the combined coverage of Medicare and Medigap took care of most of the bills. My mom really doesn’t want to change that coverage and I certainly can understand that. It’s nice to have insurance which doesn’t whine about the bills but just takes care of them. As an aside, I’ve received most of the bills for my cancer surgery and they total up to about $65,000.00. I have Blue Cross Blue Shield and they are covering all but about $1000.00 of it. Since Blue Cross and Blue Shield do not offer a Medicare Advantage program in Arkansas (where my mom lives), that rules out this option.

We then had to decide whether or not it was worthwhile to enroll in Medicare Part D (Prescription Drug Coverage). At first glance it certainly seems attractive; the government is offering huge subsidies to various private companies to help underwrite these plans. Prescription Drugs ARE cheaper this way, but as I mentioned in my previous posting on this subject, my mother only has one prescription medication she currently takes. That’s only one consideration, of course. If she doesn’t enroll in a plan by May 15th, she’d be unable to do so until November 15th. If something happened to her in the meantime, she’d be on her own in paying for prescription medication until November 15th. In addition, Medicare imposes a penalty of 1% per month for each month one delays in subscribing to Part D. So, I wanted her to join a plan and had hopes of finding one which wouldn’t cost her any more out of pocket than what she was paying now.

Finding a plan can be a bit tedious. What plans are offered depend on which county a person lives in. For example, my mom lives in Benton County in Arkansas. There are currently 41 Prescription Drug plans available for this county. Which one to choose? Well, that depends on which prescription medications you are taking or think you are likely to take; each plan has its own options as to what drugs it covers, how it covers them (copays and deductibles) and which pharmacies you can use.

Fortunately, the government Medicare website is a pleasant surprise; it actually is very helpful in determining what your options are. But the key to using it is to have the proper information. You need to know which prescription drugs are to be covered (including dosages) and the county the person to be covered lives in. Once you have this information, you can plug it in and the website will then prepare a list of all plans available in that area and their costs. By doing this, I found a Humana plan for my mom that saves her money; the yearly cost of the premiums and her prescription medication under this plan is cheaper than what she is paying now for the medication alone. In addition, she’ll now be enrolled in a Prescription Drug Plan so if she needs to start taking additional prescription medication in the future, she’ll be covered. Finally, since she’s now enrolled, she won’t be subject to that odious 1% per month penalty. All in all, a good deal. Of course, the taxpayers are paying for this, but that’s another story altogether…

I found the Jane Bryant Quinn article I mentioned earlier to be absolutely spot-on in its recommendations; she’s clearly done her homework and I highly recommend it as a resource for you. That article, plus the government Medicare website should be all you need to know to figure out your best option.

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