Best Drug Plan May Depend on Coverage You Already Have
By LARRY LIPMAN Palm Beach Post Washington Bureau
Unlike traditional Medicare coverage, which offers the same benefits to everyone in the program, Medicare prescription drug plans are sold through private companies and the costs and benefits vary from one plan to another.
Medicare and consumer groups list about a half dozen “common situations” of beneficiaries:
Original Medicare program, including those who have a supplemental policy that does not cover drugs: Beneficiaries can stay in their current plan or join a Medicare Advantage managed- care plan that offers drug coverage. If they stay in their current plan, they may sign up for an additional drugs-only plan sold by a private Medicare-approved prescription drug provider. Generally, the plans will cover about half of the cost of prescriptions.
Original Medicare program with a medigap policy that includes prescription-drug coverage: Beneficiaries can stay with their current plan or join a Medicare Advantage plan. If they stay with their current plan, they might find their drug payments would be less with a private prescription-drug provider. Beneficiaries could sign up with a drugs-only plan and drop the drug portion of their medigap policy. After Jan. 1, new medigap plans will not provide drug coverage. Existing plans can be renewed.
Retirees with coverage from their (or a spouse’s) former employer: Companies that provide retiree health and drug coverage – which now will get a Medicare subsidy – are supposed to send a letter to their former employees detailing the extent of their drug coverage. Most retiree plans are more generous than the Medicare benefit. Retirees who stay with their former employers’ plan will not have to pay a penalty to enroll in a Medicare-approved drug plan if their retiree plan expires in the future.
Medicare managed-care plans – formerly called Medicare Plus Choice, now called Medicare Advantage: Virtually all Medicare Advantage plans, including new preferred-provider organizations and private fee-for-service plans, will offer a drug benefit with little or no additional cost. Beneficiaries should make sure the drugs they take are covered by their plan. If not, beneficiaries may enroll in a stand-alone prescription drug plan.
Veterans Administration: Generally, VA drug benefits will be better than those provided by Medicare. Spouses eligible for Medicare who are not covered by VA benefits are being advised to consider purchasing a Medicare drug plan.
Low-income beneficiaries not on Medicaid: Beneficiaries with low incomes can get assistance paying for their premiums, deductibles and co-payments. For example, individuals with monthly income below $1,077 and married couples with income below $1,444 will not pay any premium or deductible and will pay $2 for each generic drug and $5 for brand-name drugs. Their assets – not including their home – must be below $7,500 for an individual and $12,000 for a couple. Premium subsidies are available for those with slightly higher incomes and more assets.
Medicare and Medicaid recipients: Beginning Jan. 1, beneficiaries covered by both Medicare and Medicaid will be automatically enrolled in a Medicare-approved drug plan. They will be allowed to switch to a different plan at any time. Such “dual eligible” will have the full cost of their Medicare drug premium paid by the program.
larryl@coxnews.com