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Medicare Part D: Crapshoot Coverage

category_bug_journal2.gif In a month, on 15 November, the six-week enrollment period for 2010 Medicare Part D plans begins. The Medicare Prescription Drug Plan Finder is now available at the Medicare website. It is not too soon to investigate the details of plans available in your state particularly because most insurance companies have increased premiums for next year and some have added deductibles.

Remember too, that there will be no cost-of-living increase in Social Security next year, so keeping down costs is essential.

The Kaiser Family Foundation has issued a report on availability of plans for the new year and analyzed the changes. Among them for stand-alone (not Medicare Advantage) plans:

  • Monthly premiums average 11 percent above those for 2009

  • If you stay with the plan you have now, average monthly premiums will be $38.85, up from $35.09 this year

  • 80 percent of plans have no doughnut hole coverage

  • 61 percent of plans charge a deductible, up from 45 percent in 2009

The Kaiser report notes that premiums for some of the most popular plans have increased dramatically since Part D went into effect in 2006. The AARP Preferred plan premium has doubled since then; Humana PDP Enhanced premium has tripled.

If you take more than two or three prescription drugs, deciding whether to keep your current plan or find a new one can be difficult. It's a good idea to make a chart to compare drugs covered, their costs, monthly premiums and deductibles. The Medicare Part D website is well designed. You can plug in the drugs you use and the software will pop out the plans that cover them in your state and give you cost comparisons for the variables.

People generally believe the doughnut hole (during which there is no coverage for out-of-pocket costs between $2380 and $4550) is the worst aspect of Part D. I disagree. Although the doughnut hole is cumbersome, unfair and expensive, created only as a giveaway of billions of dollars to pharmaceutical companies, there is another problem that is worse, a giant flaw in the logic of the system:

It is not possible to predict what new drugs one might need during the year of enrollment.

Different Part D plans cover different drugs. Might I suffer a stroke? Or be diagnosed with cancer? Perhaps I will develop heart disease. Even if I could predict the future, there are thousands of drugs physicians can choose from to treat health problems. Perhaps the one my physician believes is best for my condition is not available through my plan.

So choosing Part D coverage is no different from betting on a roll of the dice at a craps table.

When I realized this unconscionable flaw during last year's Part D enrollment period, I was paying a $29.90 monthly premium and $75 for a three-month supply of the single, brand-name drug I was taking. I was also facing a substantial increase in the premium for 2009.

In discussing this with my doctor, she suggested that I switch to a generic drug, purchase it for $4 per month at the local supermarket's pharmacy and buy the cheapest Part D plan. Smart woman. How much more of a crap shoot is it to HOPE my Part D plan will cover any new drugs I may need than trying to GUESS what terrible disease requiring additional drugs might occur?

Either way, hope and guess are dreadful, possibly life-threatening criteria on which to base health care. Every Part D plan should be required to cover all drugs.

The premium for that cheap drug plan I have now will double in price for 2010, and a deductible has been added. Checking the Medicare Prescription Drug Plan Finder, I discovered that the monthly premium for the least expensive plan in my state for 2010 is $1.20 more than I'm paying now and includes a $175 deductible. But the premium for the least expensive plan without a deductible is so high that I save by enrolling in the first one if during the year, I need new brand-name drugs.

If that plan does not cover new drugs I may need, I will deal with it then. There is no way to know if even the most expensive plan ($87.20 monthly premium) would cover them. Meanwhile, if my drug needs remain the same, I will pay nearly $200 next year for nothing, for a just-in-case scenario that may not happen and if it does, may not meet my needs.

The best thing I can say about my Part D coverage is that due to taking only one drug, it is not complicated to work out the best (cheapest) plan for me. If your prescription needs are more complex, it's time to start working on your crapshoot coverage. You will find the Medicare Prescription Drug Plan Finder here.


At The Elder Storytelling Place today, Johna Ferguson: Claustrophobia

Comments

Excellent summary.
Part D was clearly designed for the insurance companies and drug companies, with a passing nod to the people who need coverage.

The gap is horrible, especially for those who must take a life-sustaining drug, such as insulin.

Remember, however, in your case, Part D is insurance. You're doing what I would do, playing the game by switching to the cheapest plan every year, until (with luck, never) you need a more expensive panel of drugs.

The big message to get out is there should be no feeling of loyalty to a drug plan. Check every year to see if there is something better and less expensive. AND read your mail, as October is the month when plans must tell their current members of any changes for the next year, and that could include coverage of particular drugs.

Good advice, Nan. But there is no need to wait for insurance company mailings. The Part D website is thorough and contains a complete formulary of drugs for every plan available in each state.

Fortunately, we can get by with generic drugs & the company we have for Part D doesn't charge a co-pay for generics. My husband went into the donut hole last year & for 2 months it was expensive (one of the generics is new, but still costs alot). The cost for both of us is $66 per month. It's WellCare. Twice I've had to talk to a pharmacist & they were very helpful. Hope it's ok to mention. If not, delete it.

The info about the website for Medicare is very helpful so thanks Ronni. Does anyone believe a public outcry will bring big Pharma into line? Or am I just dreaming. Dee

Our system is complex and needlessly so. Going onto Medicare was very frustrating for me with so much to understand. Watching Sicko showed how simple it is for all ages in countries like Canada, England and France. This whole thing is unfair and no excuse. My guess is the new plan from the Senate won't help with any of that as well as probably add costs to many if not all who now have Medicare. I wouldn't mind that if we were really getting a better program for the younger people but it doesn't look to me like it will do any of that for long if at all. I hope that the House and Senate will yet come together with a single payer for at least those who currently don't have insurance to change the ball game.

I just got a note from Humana in the mail saying my new 2010 Prescription Plan was in the mail and to expect it within a few days. They also sent me a small packet containing two Valium with instructions to take them one hour before opening the envelope I receive. I wonder what that means? :(

Ronnie, I agree, the website is up there and no need to wait, but I am amazed at the people who just don't bother to even read their mail let alone look for alternatives, then are shocked when they get their bill for the new premium or find one of their drugs are no longer covered. Anyone who has stayed with the same prescription drug plan since 2006 is probably vastly overpaying now.

Dee, be careful about your plan. WellCare is no longer selling plans in Wisconsin. I don't know if it is leaving any other state. However, just because your generics had no copay this year doens't mean that will stay the same for next year. As Ronnie says, check out that web site.

I just went on medicare and I am going to try to use my old policy as a supplemental policy rather than part C and D.
I have already ran into a problem with my supply of "diabetic supplies" that are covered by Medicare. I have been a type 1 diabetic for over 26 years. I feel that I have to jump through hoops not to be treated like I am a type 2 diabetic. It is always a problem since we are such a small percentage of the diabetic population, but my need are different and I don't feel like I should be treated like I am trying to cheat, because my needs are different. The fact that I am a Type 1 Diabetic should tell them that without having to do anything else.

I am enrolled in a Medicare Prescription drug plan. with AdvantraRX (Coventry Health). I am enrolled in their Value Plan. The monthly premium for 2009 is $24.50, with no deductible. I received an insurance package from Coventry outlining information and prices for 2010. The new monthly premium for 2010 will be $41.40, and has a $100.00 deductible. This is a 69% increase in premium. I was anticipating an increase in the premium; however a 69% increase with an additional cost of the $100.00 deductible is excessive, unfair, should be investigated by insurance regulators. I know of nothing that has increased by 69%. Can anyone tell me what has increased by 69% in one year?

Hi All,
Instead of trying to do a plan comparison yourself from solicitations you receive in the mail, there is a much easier resource available. I use the search and compare tool at PlanPrescriber.com. You can either find all the plans in your area by putting in your zip code, or enter your current plan and do a plan comparison. You can compare any type of Medicare plan as well as Prescription Drug Plans. I used the search tool this year and found it very helpful in making my plan choice during the annual enrollment period. Now I can sit back and enjoy the holidays!

Because of severe back/neck pain and being diagnosed with Fibromyalgia I'm on 6 prescription drugs. I've gone to the medicare part d to look at plans only to be horrified. Not only will the premium be $50 month (not too bad) but the est. drug cost is $6,000 a year -----$500.00 a month!? Are they kidding me? What am I supposed to do now, stay on my wife's insurance plan and pay the same? I thought medicare was to help those who can't work. I'd have to work just to pay Part D

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