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Use Medicare Part D "Basic 4" to help choose your drug coverage plan

Monday, November 8, 2010

Like nutrition, you can use the "Basic 4" to help you make a good decision about your Medicare Part D drug coverage for 2011.

"The Part D Basic 4 includes the plan premium, co-payments at the pharmacy, formulary (drugs covered by the plan) and restrictions," says Kris Gross from the state of Iowa's Senior Health Insurance Information Program (SHIIP).

The 2011 Part D plans were announced in early October and plans had to notify their members of any changes by October 31. Your first step in choosing a plan should be using the Basic 4 to compare what your current plan is offering to the other options available.

Part D premiums for 2011 range from $14.80 to $106.40 per month. The lowest premium plan is not necessarily the most economical for everyone because of the other Basic 4 factors. Plans can change their benefits and restrictions annually.

A plan that met your needs well in 2010 may not provide the coverage you need in 2011. It's important to check that all of your drugs will be covered and that you limit plan restrictions. Plan restrictions include a limit on the quantity that you can receive monthly, a requirement that the plan has to authorize a prescription before it can be filled and step therapy. Step therapy requires you to try less expensive drugs before you "step" to a more expensive drug.

The best tool to help with your check-up is the Medicare web site, www.medicare.gov. This site allows you to enter your prescriptions and pharmacy and get a comparison of the plans based on total annual cost. It also gives you a breakdown of the Basic 4. A step-by step guide to using the Medicare website can be found at www.therightcalliowa.gov/DrugBenefit.

If you don't use a computer consider asking family members to help you or call a local SHIIP counselor from Cherokee Regional Medical Center at (712) 225-3368, Ext. 281. SHIIP is a free, confidential service of the State of Iowa. SHIIP counselors at Cherokee Regional Medical Center are available to help you compare Medicare drug plans. You may also call the statewide toll free number, 1-800-351-4664. It would be a good idea to schedule your appointment soon as the two weeks prior to Dec. 31 will be very busy.

Nov. 15 through Dec. 31 are key dates. During this period you can enroll in a Medicare prescription drug (Part D) plan if you missed the enrollment deadline earlier. If you already have a Part D plan you can choose to enroll in a different plan for 2011.

Once again in 2011, Medicare is offering extra help with drug costs through Part D. If your income is below $16,245 as an individual ($21,855 couple) and your resources are below $12,510 ($25,010 couple) you might get help with your Part D premium and drug costs. Call your local SHIIP Counselor at (712) 225-3368, Ext. 281 or the Social Security Administration, 1-800-772-1213, if you think you might qualify.

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