Medicare drug coverage starts Sunday
KINGMAN Medicare beneficiaries need to make a decision now about which drug plan they wish to go on Sunday when Medicare takes over prescription drug coverage from the Arizona Health Care Cost Containment System.
Information on how to apply and what should be considered in choosing a plan can be found on the Medicare Web site at www.medicare.gov.
"Medicare beneficiaries certainly must find out which drugs they use are covered under any plan, along with costs for monthly premiums, deductibles and co-payments," said Roy Dickerson, executive director of Desert Canyon Community Care, a Medicare Advantage plan provider located in Prescott offering coverage in Mohave County. "A third factor to consider is whether their current pharmacy is in the network (for the plan chosen)."
The premium is the monthly cost to the consumer to participate in a Medicare prescription drug plan. In Mohave County, they range from $6.14 to $64.86, Dickerson said.
Deductibles vary by the plan and may cost up to $250 before a chosen plan begins paying for prescription drugs.
Co-payments, the amount the consumer pays for each prescription after meeting the annual deductible, also varies with the plan. Some plans offer "tiered" co-payments in which generic equivalent drugs cost $10 per prescription, preferred (brand name) drugs cost $30 and non-preferred drugs may cost $50 per prescription.
The Medicare Web site offers viewers a formulary (drug list) finder to help in searching for the right plan to match their needs. A vitally important factor to consider is the coverage gap or "doughnut." The standard Medicare coverage limit is $2,250 per month for prescription drugs.
Web site information states if someone has high drugs costs, he or she may consider which plans offer additional coverage until you spend $3,600 out of pocket. Once reaching the initial coverage limit (of $2,250), some plans require the beneficiary to pay 100 percent of drug costs up to $3,600.
Convenience is another aspect of the complex equation in choosing a drug plan. Check with your present pharmacy to see if they will accept the plan you choose for drug coverage beginning Sunday.
Low-income individuals may be eligible for extra assistance, which could reduce or eliminate their monthly premium and deductible responsibilities on a Medicare prescription drug plan, Dickerson said.
"Health care costs are expensive and many people on regular Medicare need some type of supplemental coverage," Dickerson said.
"As far as the prescription drug plans, you need to find out which one has co-pays favorable to you, is your pharmacy in their network and does the plan have a deductible. Don't get on a plan your neighbor has because he says it's good. Do the research and make sure all your needs are covered."