In an effort to find the most appropriate prescription drug coverage under Medicare, part D, seniors must work through what seems to be an endless number of combinations of coverage. The existing variations from one insurer to the next in monthly premiums, deductibles, co-pays, drug formularies, available pharmacies, mail order services and covered drug costs seem endless.
In addition to the above considerations seniors must understand the mechanics of the part D coverage. For example seniors should understand that under part D regardless of the insurance company or policy selected only $2,510 in drug costs will be covered before insurance re-reimbursement stops. This $2,510 represents the total cost of drugs (that paid by the insurance company and the senior, combined). Once $2,510 in drugs have been purchased no additional insurance coverage will be in effect until such time as the senior has spent $4,050 ‘out of pocket’ in a given calender year for prescription drugs. This gap in coverage has been labeled ‘the donut hole’.
How does a senior wade through myriad possibilities of premium costs, gap coverage, deductibles, co-pays, drug formularies, pharmacy availability, etc. to find the lowest cost coverage for his/her particular prescription drug requirements?
There is help and this help is a very effective tool for weighing all the possibilities of coverage, costs, and service. This can be found on line at the following address:
* Medicare claim number
* Effective date of part A coverage
* Senior’s Name
* Senior’s birth date
* Senior’s health status
* Zip code
Next the senior will directed to a screen which allows input of the name, and dosage of prescription drugs taken on a routine basis.
Once this information is entered the program will provide a comprehensive list of all insurers and policies offering part D prescription drug coverage in area in which the senior lives.
On the first page that displayed much helpful data is avail be for each insurer’s offered policy. For each policy the following data is shown:
* Name of the insurerand policy (some insurers offer multiple policies with different coverages and costs)
* Estimated annual cost – this includes the cost of premiums, deductibles, co-pays, and any other ‘out of pocket costs’.
* Monthly Premium amount paid per month either through deduction from the senior’s Social Security check or direct billing.
* Annual Deductible amount of out of pocket cost paid prior to any insurance coverage/payment.
* Gap Coverage (yes or no) indicates whether the policy provides coverage of generic drugs in the gap (donut hole) after $2,510 in drug costs.
* Number of Pharmacies indicates the number network of pharmacies receiving insurance coverage.
Armed with above display the senior can easily zero in on those policies which meet his/her particular requirements.
For example, if annual cost is a primary factor, the senior may consider only those plans with the lowest cost.
If continuing coverage during the gap is most important the senior may select and consider only those policies providing gap coverage.
The process of finding only those insurers and policies which meet the criteria most important to the senior can be simplified by sorting the data by any one of the above 6 fields.
For example, if annual cost is the primary concern the senior can by clicking on the column heading “Estimated Annual Cost” sort the entire report to show insurers and policies arranged from lowest annual cost to the highest.
If the senior is primarily interested in policies offering gap coverage he/she can by clicking on the column heading “Gap Coverage” sort the data to show all insurers and policies offering gap coverage policies.
Once the data has been sorted and the senior has zeroed in on 3-4plans of interest he/she can then can a great deal of helpful details withing each in suer’s plan. After clicking on the name of a plan of interest a wealth of information for the plan is displayed:
* Annual $ Premium
* Annual $ Deductible
* Annual $ Drug Cost using a network pharmacy
* Annual $ Drug cost using mail order
There is also an evaluation/rating of this insurer and plan’s performance relative to:
* Customer Service
* Getting prescriptions filled
* Drug pricing information
Next a listing of the drugs used by the senior are listed indicating:
* Name and strength of each drug
* Full cost of each drug
* Cost paid by the senior for each drug prior to reaching the gap (donut hole) ( spending $2,510 in one year)
* Cost paid by the senior for each drug after entering the gap (donut hole) (spending $2,510 in one year)
* Cost paid by the senior for each drug after spending $4,050 out of pocket in one year.
The next section of the report lists the individual drugs used by the senior and includes:
* Name and strength of each drug
* Quantity and days supply of each prescription (example 10mg, 30 day supply)
In this section the senior can edit the drug list and add or remove drugs from his/her formulary, change dosages or quantiles and the rerun the report and see the effect on projected annual costs.
The next section lists the primary local pharmacy if selected by the senior.
This section can also be used to see all available network pharmacies in the senior’s zip code and allows him/her to select any one as the primary pharmacy on which his/her costs will be calculated.
Finally, the report provides a very helpful bar chart listing projected monthly costs for the senior’s drug usage. Here, one can see the projected cost monthly and determine when and if he/she will enter the gap and if the gap period is entered the projected effect on monthly costs to the senior.
This chart is important in selecting a drug plan as these monthly cost will vary by insurer and plan depending on deductibles, co-pays, and drug costs covered by the plan. The monthly costs shown on this chart are total costs including: monthly premiums, deductibles, and co-pays. It is here the senior can and predict his monthly cost of drugs, including the effect of entering and leaving the gap.
In summary, there are many interrelated details involved in selecting a Medicare prescription drug plan. The Medicare prescription drug finder plan described above provides an excellent tool for weighing and evaluating all of the variables. Negotiating all of the possibilities without such a tool would be next to impossible.
