AMARILLO Reduced prescription costs are the goal of the new Medicare Part D program. But potential users may need to take some time to figure out how the plan will work best for them, said one Texas Cooperative Extension specialist.
Enrollment in the program opened Nov. 15, said Andrew B. Crocker, Extension gerontology health specialist here. The benefits won’t start until Jan. 1.
Nationally, 40 companies have plans to consider. In Texas, 20 companies offer 47 different plans. Plans vary on the premium rate, deductible requirements and drugs covered.
Consult local pharmacists to see what plan or plans they will honor, Crocker said. Mail ordering might be an option, depending on what drugs and plan the local pharmacist intends to utilize, he said.
If drug options are limited, consulting a physician may be necessary to see about changing prescriptions, Crocker said.
Medicare will work with insurance companies and other private companies to offer these plans, according to the Centers for Medicare and Medicaid Services. Companies will negotiate discounts on drug prices on behalf of the people who enroll.
Those who are qualified should begin considering their options immediately, Crocker said. For most participants, joining when first eligible means a lower monthly premium.
“Enrollment in Medicare Part D is optional,” he said. “But you may pay an additional premium if you do not enroll in the program within a certain period of time after becoming eligible.”
A 1 percent fee for every month eligible but not enrolled will be assessed upon enrollment after May 15, Crocker said.
“If you wait five years, you could have to pay 60 percent more on premiums than if you enrolled now,” he said.
The exception is for individuals who get their prescriptions through the Veterans Administration or a retiree plan, Crocker said.
“If you have existing coverage that is as good or better, you will not be penalized for not enrolling,” he said.
Crocker said individuals who do not have prescription drugs now but are eligible to enroll should consider signing up with the lowest cost plan to avoid paying a higher rate later.
Under the plan, monthly premiums for this insurance coverage can range from $10 to $60. The premium is locked in for one year and after the initial sign-up period, the only enrollment period will be from Nov. 15-Dec. 31 of each year, Crocker said.
The plan is not dependent on the amount of money earned or age, he said.
“If you qualify for Medicare, you qualify.”
However, the costs are per person and not per family, Crocker cautioned.
Savings can still be significant, even for those paying a deductible, premium and their share of the prescription costs, he said.
Generally, standard coverage works like this:
The participant pays a $250 deductible;
The participant pays 25 percent of drug costs from $250 to $2,250. Medicare pays 75 percent;
The participant pays 100 percent of drug costs from $2,250 and $5,100; and
If the total reaches more than $5,100, the participant pays only 5 percent of any costs above $5,100. Medicare pays the other 95 percent.
Some low-income Medicare beneficiaries may receive extra help in paying for prescription drugs through Medicare Part D, Crocker said.
Single individuals who earn less than $14,300 per year and married couples who earn less than $19,200 per year may qualify for added drug benefits, such as reduced co-payments, under certain plans, he said.
“If you think you qualify for this extra help, be sure that the plan you are considering offers the extra benefits before enrolling,” Crocker said.
Because so many options are offered and no local Medicare offices are available for one-on-one advice, potential participants might want to go online to Extension’s Family and Consumer Sciences Web site: http://fcs.tamu.edu/families/aging/ and look under senior medication issues for more information.
More information and a cost estimator is available at http://www.medicare.gov/medicarereform/minitool.asp or by calling (800) MEDICARE (800) 633-4227. The Texas Department of Aging and Disability Services can be contacted at www.txcares.org .
Before going to the cost estimator or trying to determine what plan works best, Crocker said, each individual should know what drug or the most expensive drug he or she takes, at what dosage, how often and the price paid per month.
“Then you will be able to find a plan that fits your prescription best,” he said.