Anyone who is enrolled in a Medicare Part D program for prescription drug coverage should be aware that the open-enrollment period for 2009 is underway through December 31 of this year. A beneficiary now has an opportunity to elect to change prescription plans during this specific time, but is not required to do so. If an enrollee sees that his costs will increase, or if his Part D plan does not offer the drugs he requires, it makes sense to research other plans to see if there is one that is more cost effective.
All Medicare Part D recipients should know that the ten largest plans anticipate that their premiums will rise an average of 31 percent. In addition, the co-payments on some of the plans will be adjusted significantly. Changes to the Part D standard benefit plan include the increase in the threshold where beneficiaries have to begin paying the full cost of their prescription drugs, also known as the “donut hole.”
Under the standard benefit plan, consumers will have to pay the first $295 as a deductible in 2009 and then Medicare will pay 75 percent of the next $2,405 worth of drugs on the Plan’s formulary. (A formulary is a list of the plan’s covered drugs.) After that they have a gap in coverage, i.e., the donut hole. During this donut hole gap, beneficiaries have to pay all the costs of drugs until they have paid another $3,453.75 out-of-pocket. After that, Medicare will pay about 95 percent of the cost of covered drugs until the end of the calendar year. These amounts reflect an increase from 2008 figures.
In making a determination regarding an appropriate plan, each enrollee should have a list of all the prescription drugs that he or she requires. Each prescription plan covers different medications and also has different tiers of medications. One plan may differ from another in terms of what tier a specific medication is on. The different tiers have different payments ascribed to each medication. In addition, in order to reduce their costs, enrollees should check with their physicians to see if a generic drug may be used in lieu of a brand-name drug.
One resource that is available for interested enrollees is the Medicare website located at www.Medicare.gov. Once in this website, the enrollee should click on “Medicare Prescription Drug Plan Finder.” This site is an interactive tool that allows individuals to narrow their search for a Medicare prescription drug plan based on their personal preferences such as cost, drugs covered and participating pharmacies. It allows for consumers to compare different plans and to also view the difference in cost when filling a prescription by mail-order.
In light of the proposed increases, it behooves each Medicare Part D enrollee to take advantage of the open enrollment period and review his/her plan carefully. Even if one decides to remain with his or her current plan, it should be a well thought out and informed decision.
Ronald Fatoullah & Associates is highly recognized throughout the New York area for their expertise and outstanding services in the areas of elder law and estate planning. Ronald Fatoullah is proud to have been selected as one of New York Magazine’s “Best Lawyers” for three consecutive years in the fields of elder law, trusts & estates, and he is the legal advisor to this magazine. This article was written with the assistance of Stacey Meshnick, Esq. senior staff attorney and Medicaid supervisor at the firm.
