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November 2, 2005

How to Choose a Medicare Prescription Drug Plan

Montanans who are eligible for the new Medicare Part D prescription drug coverage will be able to choose from among 47 different plans, including seven Medicare Advantage plans.

If you are a Medicare beneficiary, you can enroll in the Part D plan of your choice starting Nov. 15--regardless of your income, health status, or prescription drug needs. If you join a plan by Dec. 31, your coverage will begin Jan. 1, 2006. If you wait until after Dec. 31, your coverage will be effective on the first day of the month after the month you join. If you don't join by May 15, 2006, you will have to wait until Nov. 15, 2006 to join.

If you already have prescription drug coverage (through an employer or union, for example), you should review the coverage to see if a Medicare Part D plan can replace or augment it. Your current insurer should automatically send you information about how your current coverage will work with the Medicare prescription drug coverage. Check with your benefits administrator if you have not received this information.

If your existing coverage is as good as or better than Part D coverage, you need not enroll in Part D.

Medicare prescription drug plans vary, so before you choose one, shop around to find the one plan that best suits your individual needs. As you do, you'll want to compare cost, coverage, and convenience.

Here are some points to consider when making a decision about which plan is best for you:

Cost

  • Compare the cost of the monthly premium. If you have limited income and resources but don't qualify for Medicaid, you may be eligible for "extra help" paying your premium from the Social Security Administration or the Montana Big Sky Rx Program.
  • Compare the cost you will be required to pay for each prescription. It may be a set amount (a copayment, for example, $5), or it may be a percentage of the total cost of the drug (coinsurance, for example, 25 percent).
  • Compare yearly deductibles. Plans offered in Montana offer yearly deductibles ranging from zero to $250.

Coverage

  • Make a list of the name, dosage, and cost of the prescriptions you use. This will help you choose a plan that meets your prescription drug needs, because not all plans will cover the same drugs.
  • Decide whether you want a plan that will manage your Medicare Part A, Part B, and Part D--called a Medicare Advantage plan with prescription drug coverage-- or if you want to keep your traditional Part A and Part B coverage and get your prescription drugs from a Medicare approved prescription drug plan. Medicare Advantage plans may offer additional benefits not available through traditional Medicare, although they may also restrict your choice of health-care providers.

Convenience

  • If it is important to you to continue using a specific pharmacy to get your prescription drugs, be sure to choose a plan that has your pharmacy in its network.
  • Or if you prefer to use mail order for your drugs, choose a plan that offers the mail order option.

You should recently have received a copy of the "Medicare and You 2006" handbook in the mail. This useful tool, created by the Centers for Medicare and Medicaid Services, contains additional information about choosing a prescription drug plan or a Medicare Advantage plan with prescription drug coverage. The handbook also includes a list of nearly all plans available in Montana , along with telephone numbers and information about monthly premiums, cost sharing, and deductibles.

However, be aware that this list has incorrect information about the share of the monthly premium paid by Social Security's "extra help." The extra help, or subsidy, will pay no more than $33.11 a month. If you qualify for the extra help and don't wish to pay additional amounts for the premium, choose a plan with a premium of not more than $33.11.

Even if you don't use a lot of prescription drugs now, you should still consider joining a plan if you don't already have prescription drug coverage as good as Medicare Part D coverage. As we age, most people need prescription drugs to stay healthy. For most people, joining now means you will pay a lower monthly premium than if you wait until later to join a plan.

If you have questions about choosing prescription drug coverage, contact the State Health Insurance Assistance Program (SHIP) at 1-800-551-3191 or call your local Area Agency on Aging.

You can also find a list of plans available in Montana , as well as a tool called the Medicare Prescription Drug Plan Finder online at www.medicare.gov .

For more information about the extra help with premiums that is available through Big Sky Rx, visit www.bigskyrx.mt.gov or call toll-free 1-866-369-1233. For more information about the extra help available through Social Security, call 1-800-772-1213 (TTY 1-800-325-0778) or visit www.socialsecurity.gov .

(This column was prepared by the Montana Department of Public Health and Human Services. It is the sixth in a series of monthly articles about the new Medicare Part D prescription drug benefit that will take effect Jan. 1, 2006. To read other columns in this series, visit www.dphhs.mt.gov and click on "New Medicare Prescription Drug Benefit" under Features.)

Page last updated: 06/15/2006