How can we choose the right Medicare Advantage plan -- and, if necessary, switch plans?
First, make a list of the drugs the potential subscriber to the plan needs. Then check with each plan to see which drugs are included in what's called its drug formulary (note that the list changes every year). If more than one plan covers all the drugs, choose the plan that has the fewest restrictions on access to those drugs and the lowest total costs (not just the lowest monthly premium). Check whether the plan waives any of the deductible, and total up the co-payments the patient would pay per prescription. Also consider what coverage is available, if any, within the "doughnut hole." Finally, check to see whether the pharmacy the patient prefers participates in that plan.
A plan that looked good initially may turn out to be a less-than-ideal choice. It may have restrictions that didn't seem especially important when you signed up for it but have since proven to be a problem. The plan might have changed its formulary more than most from one year to the next, changed its rules or restrictions, or raised its premiums. Or maybe a new plan is now offered that has better terms. In any of these situations, subscribers can leave their current plan and enroll in a new one. But they must do so by signing up during the open enrollment period from October 15 to December 7.
Where can we find more information about joining a Part D plan?
Medicare's website has information about Part D drug plans available where you live, including the medications currently in each plan's formulary. Or you can contact Medicare by phone at (800) 633-4227. You can get free, independent expert help in choosing a plan from your local State Health Insurance Assistance Program (SHIP). You can also get independent help online from the Medicare Rights Center.
Once you've gathered information about plans and narrowed their choices, it's time to directly contact the plans that seem the best. It's only from the plans themselves that you can be sure to get the latest information -- in writing -- about coverage, costs, and restrictions. Once you decide on a particular plan, you enroll directly with it, not with Medicare.
I've been a Part D participant since the program began. Part D hasn't helped me at all. Prior to Part D, the insurers providing Medicare Part B, offered supplementary prescription drug coverage options. The premium cost for these drug coverage plans was approximately the same as that of Medicare Part D. The difference is that the pre-PART D Plans put a cap limit on annual coverage. However the limited annual coverage was between $1800-$2200 per year; which was a much higher amount, than was the low end of the Medicare Part D Prescription coverage doughnut hole, when the plan went into effect. And this was more than 5 years ago so, undoubtedly, left alone without Govt meddling, the coverage amounts would have increased by now. Hence, the free market provided a better coverage for less money than Medicare Part D, to individuals like me, who pay more than average for drugs per annum, but less than someone requiring catastrophic prescription drug coverage. Today, my total out of pocket prescription drug costs, are more for the same medications, than they would have been if the Government had never created Medicare Part D. I realize that some people, probably most people have benefited greatly from Part D, however, I have not. I’ve been damaged and the fact that I am now trapped, without a better available option; is further proof of how Government, by definition can never adequately provided for the individual citizen.
First call Medicare & ask for advice, you should also contact the maufacturer of the drugs you need & see if they'll help you. Good luck
I am 60 years old and drawing my exs social srcurity.It they put me on medicare and it leaves me paying $122.00 of my meds.I don"t have enough money to get my meds. I am a diabetic and take insulin and other meds. without these I could die.What can I do?