Medicare PART D

Homework is Key for Medicare Part D

By Dana E. Bookbinder, Esquire

By now, we have all been introduced to the new Medicare Prescription Drug Plan, also called Medicare Part D.

Regardless of how much time you have spent trying to understand the new Medicare Part D program, you have probably discerned one primary fact: it's complicated.

Now that the program has begun with the new year, a worthy resolution would be to make sense of it - and then sign up.

For those who do not have an alternate equal or better prescription plan, the deadline to sign up for a Medicare Part D plan under the program without penalty is May 15, 2006. It is important that you select a plan that covers the prescription medications that you take and is accepted by the pharmacy where you purchase them. Those are the first things you must verify.

Each plan requires a monthly premium that you must pay and, in addition, each may require an annual deductible of up to $250 be satisfied before the discounts kick in. Details on the standard plan were included in Begley and Bookbinder's September 30, 2005 Alert.

If all the plans stuck to the standard formula, signing up would be easy; an individual would simply select any plan offered by his pharmacy that includes his particular medications. However, it's not that simple, because of the large number of plans and because each offers its own variation of the standard plan.

To provide help, the government maintains a Help line, (1-800-medicare) and also an internet website (www.medicare.gov). Approximately 19 companies offer Medicare approved prescription drug plans in New Jersey, and some offer as many as 3 options for a total of about 45 choices. The government Help line assists you in comparing three plans.

Those of you with Internet access may want to see the plans for yourself. I found the Internet to be not user friendly because for each prescription that is entered, and for each dosage, the user must switch between web pages. Be prepared to spend substantial time online, especially the first time. Those with high speed access will get quicker results.

The website gives you the option of entering your specific pharmacy or of simply requesting the best prices in your area. The website will display all the plans available to you. For each plan, it will give you a phone number to call for further information and to enroll (it is also possible to enroll directly via the website). It also gives the monthly premium, the deductible, your monthly out-of-pocket 25% cost share, and your total annual estimated cost; including the premium, taking into account the deductible and the coverage gap.

It also gives you the option of selecting cost details for any one plan at a time. That option provides the user the cost of each medication, both the 25% discounted price and the full retail price.