Health Watch By Steve Mullenix

Special to The North Jefferson News




The end of the year brings us thoughts of sharing the holiday times with friends and family.

Sharing parties, meals, exchanging gifts with friends and loved ones is often one of the most carefree and joyful times of the year.

But in recent years, for many of our seniors the end of the year is a time of stress and anxiety regarding their selection of a new prescription drug program for the coming year. This year in Jefferson County there are 53 Medicare Part D Drug programs, 24 Medicare Health Plans and 16 Special Needs Plans from which to choose.

For the average consumer, this wide selection can be quite confusing if not overwhelming. Selection of the incorrect plan can sometimes cost the individual more than it should in monthly premiums and copays, not to mention forcing him/her to find other physicians or drugs that are covered by a newly selected plan.

Let’s look at some of the dates to heed:

• November 15, 2007 – The first day you can change your plan for the 2008 year

• December 31, 2007 – The last day you can change your plan for the 2008 year

• January 1, 2008 – Newly selected benefits begin

Now is the time to start thinking about what to do for the upcoming year.

It’s also good to understand some of the basics about Medicare before you begin. Medicare is divided into several different types of coverage:

• Medicare Part A – (Hospital Insurance) – Covers the insured for inpatient care while in the hospital, and certain care programs like skilled nursing facilities and hospice

• Medicare Part B – (Medical Insurance) – Helps cover medically necessary programs like doctors and out patient services

• Medicare Part C – (Medicare Advantage Plans) - Another way to get Medicare benefits. It combines Part A, Part B, and sometimes Part D. These coverage types are managed by private insurance companies approved by Medicare.

• Medicare Part D – (Medicare Prescription Drug Coverage) – Helps cover prescription drugs.

Now that we understand the basics, let’s focus on Part D, which offers the most selections and has caused the biggest amount of confusion.

As stated earlier, there are 53 different PDPs (Prescription Drug Plan) available in Jefferson County. There is a vast difference in the coverage offered by these plans with regard to deductibles, copays and gap coverage.

Deductibles for the vast number of plans range from zero to $275 per year. Monthly premiums range from $18 to $98 per month. Some plans offer no coverage during the gap, others continue to provide coverage, but only for generics.

Speaking of the gap, those amounts have changed this year as well. The 2008 gap begins at $2520 and ends at $5726 (or your out-of-pocket amount of $4050.00).

My experience has shown me that the cheapest monthly premium, in some cases, can cost an individual thousands more a year due to his drugs being at higher copay levels. The only (and I state again “only”) way to select the BEST plan is to review your current drug profile against all the plan formularies and calculate your estimated yearly expense.

However, this method is not without flaw, because of the fact your drug regiment can and most likely will change over time. This leaves some room for error in the calculations.

Seek the guidance of your pharmacist, as he/she knows the current drugs you are on and should be able to offer you some direction in selecting the appropriate drug plan for you. You can go to the CMS web site at www.medicare.gov and input your current drug regiment and review where your drugs fall in different copays for all the different plans.

I would also suggest that you be aware of some of the less than professional marketing tactics which some of the plans may be utilizing.

Making a decision on the spur of the moment is not the best option. Know your time table — you have until December 31 to make a change.

Ask questions, seek the assistance of your family and friends and ask your pharmacist for advice.

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