It's Medicare Drug Plan Time

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Q: I want to change my Medicare Drug plan. Can I get help?

A: If you are eligible for Medicare Part A or Part B, you are eligible for Medicare D drug coverage.

There is no screening for pre-existing conditions or high drug costs.  Plans must take everyone who is eligible and enrolls. You can join Medicare Part A, Part B and a drug plan during the three months before your birthday.  You can also join for up to three months after your birthday.  You don’t have to enroll in a Medicare drug plan if you don’t want to. But if you are eligible for drug coverage and you don’t join, you will have pay a penalty if you join later---unless you are eligible for the extra help with costs. In some cases, you may be able to keep your current prescription drug plan and not join a Medicare drug plan, and you may not have to pay the penalty.

Medicare drug plans change every year, and so do your needs. Each year, you should look at your plan to be sure it's still right for you. You have until December 31st to sign up for a Part D drug plan for the first time, or to change the plan you have now. There are 34 Medicare drug plans in Massachusetts to choose from. Medicare.gov has the best tool to help you. It’s called the "Prescription Drug Plan Finder." You enter your drugs and the name of your pharmacy. Then the tool will tell you which plans are available, how much each one will cost. You can compare the different plans and decide which one is right for you. In most cases, you should look for plans that have the lowest OVERALL annual cost each year---which includes your premiums, deductibles, co-payments or co-insurance for each prescription, and any drug costs you pay during the coverage gap known as the “donut hole.”

Before searching, start off by making a list of the drugs you take and the pharmacy, doctors, and other health-care providers you prefer to use. Then ask these questions:

• Does your plan cover all of your drugs at an affordable price?
• Will it continue to do so in 2011?
• Will your premiums and other costs change in 2011?
• Are there other plans in your area cover your drugs for less? See if another plan can cover your drugs at a lower cost or with fewer restrictions.
• Are you able to get your drugs at the pharmacy of your choice?
• Does your plan offer mail order delivery?

By switching, you could save money, and get more of your drugs covered. If you want to switch to a different plan, it's best to do so by early December, so your new plan will be ready to start on January 1. When you join a new Medicare plan, your coverage will be switched automatically on January 1. You can only be in one plan at a time. If you decide to stay with your current plan, you won't need to do anything.

If you joined a Medicare Advantage Plan, and you want to switch, you can do so from January 1 to February 14---but you cannot use this time to switch to another Medicare Advantage plan. You can return to the Original Medicare plan.

If you join a Medicare Drug plan, you will be required to pay monthly premiums, a yearly deductible, and co-payments or co-insurance for each prescription. But if you are on a limited income, you will pay only low or no monthly premiums, deductibles, and co-pays.

If what you and the drug plan pay for your prescriptions are greater than $2,830 in 2010, you will probably hit the “donut hole” coverage gap. From that point on you will pay 100% of your drug costs until your out-of-pocket costs reach $4,550 (or your total drug costs hit $6,440). After that, you will pay either 5% of the costs of prescriptions on your plan's drug list, or a co-pay of $2.50 for generic drugs and $6.30 for brand-name drugs on your plan’s list.  Some plans pay for drugs in the donut hole. These plans may pay for generic drugs, and possibly some brand drugs. Premiums on these plans may be higher. Remember to choose the plan with the lowest OVERALL annual costs per year.

In 2010, people with Medicare who don’t qualify for low-income help, will get a one-time, tax-free rebate check of $250 if you reach the coverage gap. You will automatically get this check from Medicare within 45 days of hitting the gap.

Picking a new drug plan, or switching from an old one, can be very complicated. You can get free help from a Massachusetts SHINE counselor by calling 1-800-AGE-INFO. To speak with a Medicare representative, call 1-800-MEDICARE anytime day or night.