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Medigap, Medicare drug coverage plans: What you need to know

Tom Cruze~Sun-Times file photo

Tom Cruze~Sun-Times file photo

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Updated: May 3, 2013 12:15PM



Dec. 7 is the deadline for America’s seniors to make some difficult and important decisions about one of the most complex, confusing, and costly aspects of their life. This is the once-a-year opportunity for seniors who have Medicare Advantage and Part D prescription drug coverage to switch to a plan that may offer better coverage — at less cost. For seniors with a Medicare Supplement Plan also known as a MediGap Plan, they can change their plan anytime during the year, but it may require underwriting, which could increase the price or disqualify you from being covered under that plan.

Unfortunately, Medicare decisions are not a one-time kind of thing. In fact, you need to review your Medigap and Part D (prescription drug) programs or Medicare Advantage program every year — even if your health situation did not change. You might find that the plans, coverage, and prices have changed since last year. Some popular drugs have gone generic in the past year, affecting prescription drug costs. So it really is worth going through the process again.

And since the most efficient way to do this is on your computer, I am appealing to the younger generation to sit down with Mom and Dad or Grandma and Grandpa before you turn on the football games this holiday weekend. They may really need your help to get through this process.

Critical comparisons

The key programs you want to compare are your Medicare Advantage plan and your Part D Prescription Drug plan to see if those are giving you the best coverage in your area — since most of those Advantage Plans “bundle” all of Medicare parts into one monthly payment, with a “cap” on your out-of-pocket expenses.

The place to start this process is a terrific website that is designed to easily help you do the comparisons. At

PlanPrescriber.com

, more than 6 million people will use the calculators to compare thousands of offerings from various companies for Medigap supplements, Part D, and Medicare Advantage programs. A recent survey of their users found average savings on Part D of $654 per year over their current plans.

Even better, if you get confused, you can call their toll-free number — (888) 312-5447 — and they will help you over the phone. This is an unbiased comparison from experts who will actually help you choose a plan, get signed up, set up an automatic monthly payment from your checking account and hold your hand through the process. Or you can do it all online, from research to sign-up. There is no additional cost to the consumer for either personalized help over the phone or applying online through the PlanPrescriber.com website.

(Medicare.gov has a similar tool, but it’s not as user-friendly, nor does it offer personal guidance in making a choice.)

Comparing Part D drug plans

Start by lining up all your prescription drug bottles so you’ll be able to enter the exact prescription and dosage. Then go to www.PlanPrescriber.com and click on “Part D — Drug Plans.” You’ll be asked if you have a current drug plan so you can do the comparisons. Then input the names of all your drugs and the dosage. With a few clicks you’ll be able to compare plans based on monthly premium, deductible, gap coverage and other factors.

Since last year, popular drugs like Lexapro, Plavix, and Lipitor became available in a generic version. In 2013, Singulair, Cymbalta, and Niaspan go generic — all affecting your plan decision.

And while you’re choosing plans, remember to consider mail-order of a 90 day supply for maintenance drugs, as well as the convenience of your local pharmacy. That decision could go a long way to lowering your overall costs.

Comparing supplement plans

To get started on the comparison of MediGap plans at PlanPrescriber.com, all you need is your Zip code! But that’s the only simple thing about choosing a supplement, since there are literally hundreds of different offerings, standardized, with plans ranging from “A” to “N” — all explained in a simple chart. The greater the supplemental coverage, the higher the cost. The trick is in finding the correct and maximum coverage, while minimizing the monthly premium. That’s where the combination of computer research and personal hand-holding can be the most help.

Comparing Medicare Advantage

When you see how the costs of Part D and your supplement add up each month, you may want to use the PlanPrescriber.com search feature for Medicare Advantage, which bundles all aspects of Medicare into one monthly premium. Nationally, nearly one-third (31 percent) of Medicare Advantage plans in 2013 will be available for $0 above what a person already pays for Medicare Part B, but some plans do have additional monthly premiums.

Medicare Advantage plans must — by law — cap your maximum out-of-pocket (MOOP) costs at $6,700 or less. The 2013 average will be $4,516 annually (plans have already been filed). Those costs include co-payments on drugs, so you’ll need to make sure your drugs are covered and find the co-pay amount before choosing a Medicare Advantage plan.

Some Advantage plans may offer much lower maximum costs — but may increase your cost-sharing requirements for certain services such as staying in a skilled nursing facility. That’s why you’ll want help in comparing the plans, based on cost and coverage. But most important, you’ll want to be sure that your current physicians and hospitals are in the network of the plan you choose.

You’ve seen the television commercials aimed at seniors and likely received many mailings from MediGap and Part D drug plans. But, you have no real way of knowing what’s best for you without doing comparisons. Don’t panic. Help is available. Take full advantage of this opportunity. It is certainly worth the effort. And that’s The Savage Truth!



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