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How to compare Medicare prescription drug plans

Published: Thursday, Nov. 1, 2012 11:19 a.m. CDT

Dear Savvy Senior: Is it important to compare Medicare Part D prescription drug plans every year? My pharmacist recommends it, but it’s such a hassle sorting through all those different plans. What can you tell me? — Confused Beneficiary 

Dear Confused: Because all Medicare Part D prescription drug plans can change their costs and coverage each calendar year, comparing plans every year during the open enrollment period (which is Oct. 15 to Dec. 7) is still the best way to ensure you don’t miss out on your best deal for 2013, especially if you take a lot of medications. 

Here are a few tips and resources that can help you compare plans with the least amount of hassle. 

Online Tool

If you’re comfortable using a computer, you can easily compare Medicare’s drug plans yourself online. Just go to Medicare’s Plan Finder Tool at www.medicare.gov/find-a-plan, and type in your zip code or your personal information, the drugs you take and their dosages, and select the pharmacies you use and you’ll get a cost comparison breakdown for each plan available in your area. 

This tool also provides a five-star rating system that evaluates each plan based on past customer service records, and suggests generics or older brand name drugs that can reduce your costs. 

It’s also important to keep in mind that when you’re comparing drug plans don’t judge a plan strictly by its monthly premium cost. Low-premium plans are often associated with higher prescription co-payments and may end up being more expensive. Look at the “estimated annual drug costs” that shows how much you can expect to pay over a year in total out-of-pocket costs — including premiums, deductibles and co-pays. 

Also, be sure the plan you’re considering covers all of the drugs you take with no restrictions. Some plans may require you to get permission or try a number of cheaper drugs before they will cover certain prescriptions. 

Get Help

If you need some help with this or if you don’t have Internet access to compare the plans yourself, ask your kids, grandkids or a trusted computer-savvy friend to help you, or you can call Medicare at 800-633-4227 and a customer service representative will do it for you over the phone for free. 

Another resource that you can call on for help is your State Health Insurance Assistance Program (SHIP), which provides free one-on-one Medicare counseling in person or over the phone. They also conduct seminars during the open enrollment period at various locations throughout each state. To find the contact information for your local SHIP visit shiptalk.org, or call the eldercare locator at (800) 677-1116.

Smaller Donut Hole

You also need to know that Medicare’s “donut-hole” coverage gap will shrink a little more next year. In 2013, Medicare Part D beneficiaries that hit the coverage gap will receive a 52.5 percent discounts on brand-name drugs, and a 21 percent discount on generic medications. 

For 2013, the coverage gap begins when your total drug cost exceeds $2,970 (that includes your share and the insurer’s share of the costs) and ends when combined spending is $6,733. After that, your Part D plan usually covers around 95 percent of your remaining drug costs for the year. 

Low Income Assistance

Also, be aware that if you’re a low-income beneficiary and your annual income is under $16,755 or $22,695 for married couples living together, and your assets are below $13,070 or $26,120 for married couples, you may be eligible for the federal Low Income Subsidy known as “Extra Help” that pays Part D premiums, deductibles and copayments. For more information or to apply, call Social Security at (800) 772-1213 or visit socialsecurity.gov/prescriptionhelp.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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