Editor’s Note: If you’re on Medicare, you’ll need prescription coverage. But how do you find a plan?
With Medicare open enrollment underway through Dec. 7, Making Sen$e has turned to journalist Philip Moeller, our “Medicare Maven,” to guide readers through some of this period’s important decisions and take your questions. In Wednesday’s column he tackles Medicare Part D prescription drug coverage.
As he explains, drugs plans make lots of changes to their plans each year, so it’s important to determine which plan in your geographic area will best meet your needs for the price you’re willing to pay. And the fastest way to do this is online, he advises, using Medicare’s Plan Finder. The site gets high marks from independent experts, he points out, but it’s not exactly user-friendly.
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That’s why Phil is here. Below, he walks readers through how to Plan Finder.
Moeller, who writes widely on health and retirement, is a research fellow at the Sloan Center on Aging & Work at Boston College and co-author of “How to Live to 100.” Follow him on Twitter @PhilMoeller or email him at firstname.lastname@example.org.
— Making Sen$e Editor
Plan Finder is the online tool developed by Medicare to help you find the most suitable Part D Medicare prescription drug plan. It includes all the medicines offered by insurers and lets you select the plan that gives you the best deal on the specific medications you need to take.
If you’re using Plan Finder, you can take a visual tutorial first, or plunge right in by entering your ZIP code.
I am not on Medicare and thus used the tool’s general search option. It has four steps:
- Indicate the type of Medicare drug plan you have and whether you get any payment support from other federal programs. You can always say “don’t know” to move on to the next step.
- Here’s where you enter information about the drugs you take. Do not be in a hurry here. Plan Finder will save your choices, so once you have completed your list, write down the “Drug List ID” number and the “Password Date.” This will allow you to access your drug list later to change it or do additional plan research.
- Select your pharmacies. You should see a list of pharmacies in your ZIP code.
- Refine your results. This is by far the trickiest part of using the Plan Finder, and it just may send you screaming to the nearest SHIP counselor to take advantage of the free Medicare counseling this program provides. Medicare allows you to tailor your plan choices in no fewer than eight ways:
- The monthly premium you want to pay: $0 to $139 for plans offered near where I live, for example. There are 34 service areas around the country, so make sure you’re getting details on the plans offered where you live.
- The annual deductible; the national maximum is $320 but many plans offer smaller ones.
- Drug options, such as showing only those plans that provide all the drugs on your list or that provide mail-order pricing.
- Looking at plans that only receive certain Medicare star quality ratings; 1-5 stars are offered.
- Coverage options that include nationwide coverage and that allow you to see any doctor.
- Plans that cover special needs for people who qualify for Medicaid and Medicare, people with certain chronic diseases or conditions, and people in certain long-term care facilities.
- Allows you to enter your health status as either poor, good or excellent.
- Allows you to select plans from a list of specific insurance companies.
Tailoring your plan this way is a good idea in theory, but daunting in practice. That Medicare number again is 1-800-MEDICARE. . . .
But for those brave souls who wish to continue, and clearly have no other pressing appointments, I suggest playing with these various Plan Finder choices and seeing how they affect the drug plan choices that you see. For example, some plans with low premiums may have high deductibles or co-pays.
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Just looking at premiums, which some drug-plan guides do, is not going to tell you much about your total out-of-pocket costs. “Most people look at the premium and base their coverage decision on that,” says Jocelyne Watrous with the Center on Medicare Advocacy. “It’s far from the most important thing on which to base a coverage decision.”
Once you’ve entered all these variables and recorded them in Plan Finder, the next page will list “Your Plan Results.” After consuming more than a few cups of coffee producing mine, I felt a strong relationship with my personalized list of plans – a Match.com for health plans.
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Unfortunately, my romance was short-lived. No plans satisfied all my preferences! Can you believe, in this day and age, that you can’t find a drug plan where the pharmacist delivers the drugs to your door and then sings to you?
So back to the drawing board I went. This time, 20 plans met my criteria and I could rank them by name, annual retail pharmacy drug costs, annual mail order pharmacy drug costs, premiums, deductibles, and several other ways. I went with annual costs.
I wish I could say that my list of plans made choosing one easy. Ha! The list was just the beginning of more homework. What were the pharmacy fulfillment limitations of my plans? Restrictions on my drugs — amounts, frequency, prior authorization, and the dreaded “step therapy.” This is where the plan can force you to try a generally cheaper drug than the one you want, and see if it’s effective. Oh, wouldn’t we all look forward to a bureaucratic dance to define “effective” when our health or even life is on the line?
I narrowed my list by filtering out all but the most highly rated plans. Beyond price and drug availability, the Medicare plan rating system scores plans for service and other customer-friendly attributes. I’m not sure I would pay more money for such a plan, but if total out-of-pocket and convenience factors were about even, going with a higher rated plan makes sense to me.