Why you must look at your Medicare Advantage Plan, and
Part D Prescription Drug Plan Today
OPEN ENROLLMENT OCTOBER 15 THROUGH DECEMBER 7
December 08, 2014
You may also
want to read:
I'm Falling into the Doughnut Hole
Robert Fassbach, editor,
What you do
right now can determine how well you do, for all of
next year, in getting the medical care and prescriptions
YOU MUST CAREFULLY STUDY THE PLANS WE ARE ABOUT TO
DISCUSS - EVERY YEAR.
YOU MUST MAKE YOUR DECISIONS FOR 2014 BETWEEN
OCTOBER 15 AND DECEMBER 7.
- Around 25% of U.S. Seniors
choose a private Medicare Advantage Insurance plan to
cover their healthcare, or their healthcare plus
prescriptions. Medicare makes a monthly payment to these
insurance companies of around $800 - $1,000 for every
senior they enroll. Details of these insurance companies
vary widely, and must be studied very carefully.
I turned 65 the day before Christmas 2007, and wanted to
find a Medicare Advantage plan that covered both my
healthcare and my prescriptions . Selecting a Medicare Advantage Plan was a
traumatic experience. I have been studying and
writing about the nuances of Medicare for nearly 10 years
on SeniorArk, and in various other publications. But
until I entered the scene myself, I had no idea of the
extreme confusion surrounding the process. Even now,
having made an "informed" decision for next
year, I am not
completely sure I made the best choice for
my needs, because I am not completely sure what my needs
will be as the year unfolds . I have a plan that will
work, and it includes Prescription Drug coverage, but
Pennsylvania has dozens of plan possibilities out there,
all being offered by private insurance companies
interested more in my money than my health. During
insurance company plan presentations I heard
misrepresentation, half-truths, and outright
misinformation. But a choice was needed, so one was
MEDICARE PART D,
AND MEDIGAP -
Most Seniors stay with
traditional Medicare that pays 80% of most healthcare
expense, but does not cover most prescriptions. (Private Medigap insurance can help close the gap on the last
20%, but nothing for prescriptions. Shop for Medigap
and the Part D prescription program at: Medicare.gov.) Enter Part D.
This is yet another private insurance scheme
that is paid for by Medicare, and is designed
to cover some portion of most prescriptions. If you
enroll in a Part D plan, you will pay a premium, perhaps
an initial annual deduction, and a co-pay on each
prescription. Co-pays vary widely from company to
company, and from one "tier" of medication to another.
For example, a common generic may have a co-pay of $7,
and a higher tier generic may be $15. A common branded
drug may be $45, while a newer, higher tier branded drug
could be considerably more. You MUST study these
insurance plans carefully, taking into consideration
your anticipated specific medications.
DEALING WITH THE DONUT HOLE
Now let's assume that you have signed up for a Medicare
Advantage plan with prescription
drug coverage. Or you are in traditional Medicare with a
stand-alone part D drug plan. Then today you need to think about the
doughnut hole. The best time to begin avoiding it is
right now. I met with my doctor to go over the
salad of drugs that seem necessary to keep me going each
month. I told him I wanted to find a generic for every
one of them. He was willing to do that.
are some examples of the savings when switching from
Brand to Generic:
Celebrex 200mg, a medication used for
arthritis, costs about $100 for a one-month supply.
Replace with Meloxican 15 mg (generic for Mobic)
costs about $8. Cost difference,$1100/yr.
Lipitor 20mg, used for cholesterol, costs about
$111 for a month's supply (in 2011). Simvastatin,
(generic for Zocor) cost $11. Savings, $1200/yr.
Prevacid 30mg, a medication for heartburn,
costs about $144 for a one-month supply. Omeprazole
20mg (generic for Prilosec) costs about $27, or a
savings of $1400/yr.
Tricor 145mg, a medication for triglicerides,
costs around $100/mo. Fenofibrate (generic for
Tricor) costs $37, for a savings of about $750/yr.
the way, this is also a good time to go over your
medications to determine if you still need every one of
them. Over time, medications are prescribed that should
be given for a limited time, but they are never stopped.
Several doctors, including your specialists, may have
written prescriptions that just keep refilling
automatically long after their need ends. Doctors are so
busy these days, that many overlook this. Make them
SOME ADDITIONAL WAYS TO SAVE MONEY
Go online to see if you you qualify for
Federal help with your Medicare expenses.
Go online, (click your state on the
map at this
page) or call your state's agency on
aging, or the equivalent department, to determine if you
may actually qualify for additional state prescription help.
There is a lot of it out there. My state, Pennsylvania,
has 2 tremendous plans for couples earning less than
$31,500, and individuals below $23,500. You may be
passing up help that is staring at you. See our
"Surviving the Doughnut Hole" page for 15 ideas on
dealing with the doughnut hole.
Many retail pharmacies (ie. Walmart, Target,
grocery chain-stores like Giant Eagle) have reduced rates for
prescriptions that are commonly used (as low as $4).
Some even offer free antibiotics and other drugs. My
co-pay with my Medicare Advantage Plan is $8, so $4 is a
But be sure that they are not charging additional
amounts to your Part D or Medicare Advantage plans. To
make sure this does not happen, thus pushing you toward
the donut hole, I only get the free or reduced cost
prescriptions from the grocery store, and other drugs at
a different pharmacy. The grocery store pharmacy does
not have my insurance information, so they cannot
intentionally, or inadvertently charge my insurance
company. They had my account number, and made so many
charging errors, that I asked them to completely erase
any reference to insurance.
hope all of this adds to your options, and not to your
confusion, If questions remain, you can always search at
www.medicare.gov, or call 1-800-MEDICARE. There may
also be a state representative available to give you
So what is my choice with Medicare and/or Part "D"?
I went with HealthAmerica/Coventry/Advantra
for 2014. 2015 will be another challenging decision, but
it appears that Advantra has taken a hatchet to my
benefits, and I will be leaving them (I went with UPMC
for Life Deductible with RX). I am a government-created
gambler; I gamble on what I will need during the next
year. What a system!
final comment. I think it is obscene that our government
puts us through this traumatic, risky, confusing
process. I totally support a "single-payer" system, run
by the highly competent Medicare section of the
Department of Health and Human Services. It needs to
cover traditional Medicare, plus what is now Medigap,
and Part D. It needs to be wrapped up in
ONE SIMPLE, EASY
TO UNDERSTAND package. They can
administer the program more cheaply, and would have huge
negotiating power with drug and other suppliers (this
negotiating power was outlawed by the Republican
Congress when the prescription drug plan was passed). The
only thing standing in the way has been Congressional
backbone, and Presidential consent. Insurance and drug
lobbyists have wielded enough power to control these
programs up to this point. Until it is changed, we
must sift through this program as best we can.
Profiteers benefit from our confusion, and our unwillingness
to compare. Best
here for a link to the Medicare Part
Medicare Advantage/Medigap comparison site.