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Shopping Tips For Medicare Drug Plans

Here are some questions SHIP officials recommend asking:

Does the plan cover your drugs next year?
“All plans don’t cover all drugs,” said Leta Blank of Montgomery County’s SHIP.

Has your co-payment – the portion of the drug price you pay – changed?
Co-pays vary based on how insurers classify the drugs; generic drugs usually have the lowest co-pays.

If your drug is covered, can you get it?
Some plans have restrictions, including prior authorization (requiring your doctor to show that the drug is medically necessary before the plan will cover it), quantity limits and “step therapy,” which means the plan requires you to try a cheaper drug before you can have the one your doctor prescribed.

Medicare Drug Plans in 2012

See more on Medicare’s 2012 Part D plans:

Have you already been assigned to a drug plan?
Many seniors who receive a government drug subsidy or have both Medicaid and Medicare are randomly enrolled in a drug plan if they didn’t pick one themselves. Thousands of seniors in the Washington area who were put into some plans this year won’t be able to stay because those insurers have raised the premiums above the subsidy amount. If you are assigned a plan, check before Dec. 7 to see if it covers your drugs; if not, you can probably find one that does.

Are you in a Medicare Advantage plan?
SHIP counselors recommend looking beyond the Medicare Advantage plan’s ratings and monthly premiums to make sure that the plan covers your drugs and that your doctor or hospital participate in the plan’s provider network.

Will your pharmacy be participating in your drug plan next year?
If your plan has a “preferred” pharmacy offering cheaper drugs, consider using that pharmacy or even switching to a plan with such a pharmacy.

Can you stay out of the doughnut hole?
When you and the plan together have paid $2,930 (including your co-pays and the $320 deductible that many plans charge), Part D coverage stops until you alone have spent $4,700. This is the drug plan’s infamous “doughnut hole,” which is being closed by the 2010 health care overhaul law. While you’re in this coverage gap, you pay half of the full plan price for a covered brand-name drug and 86 percent of the plan price for a generic. After you have spent $4,700, coverage resumes and you pay 5 percent of the full price for the rest of the year. If you don’t expect to spend $4,700, try to keep drug costs below the $2,930 that sends you into the doughnut hole Buy some drugs outside your plan at, for example, one of the chain pharmacies that offer specials on generic drugs.

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Cost and Quality Medicare