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What people should consider when selecting plans


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WASHINGTON - Beginning Oct. 1, private insurers who are offering Medicare prescription-drug coverage will roll out a dizzying array of radio, television and print ads to promote their policies.

But eligible Medicare enrollees must wait until Nov. 15 to enroll.

Experts say that may be too long to expect seniors to process, retain and act on all the information they'll be bombarded with. So while the ads may alert seniors to the range of coverage options, the promotions could complicate an already-difficult decision.

Cost, convenience and coverage should be the main considerations when choosing a plan, said Hilary Dalin, Medicare coordinator for the Health Assistance Partnership in Washington, an umbrella group for consumer health programs. She offered a few tips to help make the selection easier:

- Cost: Monthly premiums will vary greatly among the plans, ranging from low or no premiums to some that could top $35 a month. While cost is important, lower premiums often require you to share more of the costs or they cover a more limited selection of drugs. Be sure to check what you get for your money. "Just the fact that there isn't a premium shouldn't be the end of the inquiry," Dalin said.

- Convenience: For many seniors, the most important aspect of a plan is "can I keep going to my regular pharmacist?" But be sure to ask specifically, "Is my regular pharmacy in the plan's network?" And if so, is it a "preferred pharmacy" or a "non-preferred" pharmacy? Preferred pharmacies offer greater discounts.

- Coverage: Make sure to ask these basic questions. Are the drugs I take on the plan's formulary? Under what conditions are they covered? Do I have to get prior approval from the plan to have drugs paid for? Will the plan require me to see if a generic medication works as well as a brand-name medication the doctor prescribes?

Ask how the plan handles situations in which a doctor prescribes a drug that isn't covered but is the only one you can take. Find out what happens when a plan does cover a particular drug but not in the dosage that you take.

Remember that plan members can switch coverage only once a year, but the plans can change the drugs they cover after giving 60 days' notice to Medicare, their network pharmacies and the patients who take the medications, Dalin said. Plans also can increase prices for their drugs by following the same notice procedure.

To help seniors, Medicare will launch a Web site in mid-October that picks appropriate drug plans based on the medications people take and the pharmacies they prefer. For more information, call 1-800-MEDICARE or go to the Medicare Web site, at www.medicare.gov

For personalized help in selecting a plan, contact your area State Health Insurance Assistance Program at www.healthassistancepartnership.org/site/PageServer?pagenameSHIPS

For additional help in selecting a plan, go to the Medicare Web site at www.medicare.gov/medicarereform/drugbenefit.asp, or visit the Center for Medicare Advocacy Web page at www.medicareadvocacy.org/CHOICES/ChoicesPartD.htm#guidelines

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(c) 2005, Knight Ridder/Tribune Information Services.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

(C) 2005 Knight Ridder/Tribune News Service.. All Rights Reserved

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