How to pick a Medicare drug plan

You may qualify for a low-income subsidy from Medicare to pay drug costs if, in 2007, your income was below $15,315 ($20,535 for a married person living with a spouse and no other dependents) and you have resources of less than $11,710 ($23,410 for a married person living with a spouse and no other dependents). To apply, call Social Security at 1-800-772-1213 or go to the agency's Web site.

You automatically qualify for extra help if you have Medicare and meet one of these conditions:

• You have full Medicaid benefits.

• You get help paying your Part B premiums from your state Medicaid program.

• You belong to a Medicare savings program.

• You get Supplemental Security Income benefits without Medicaid.

How to choose a plan

Before you examine the plans available in your area, list the medications you take and add up how much you spend on those drugs. Then go online and access the Medicare Prescription Drug Plan Finder, an online tool that allows you to compare coverage options in your area.

These online resources make it easier for you to see what kind of coverage each plan offers. They help you to identify plans that will be accepted by your preferred pharmacy (and other nearby pharmacies), as well as highlight which plans provide for additional cost savings, such as those available through mail-order prescriptions.

People taking a large number of medications might find that no one available plan's formulary will really fit their needs and, in such cases, a doctor's assistance could prove helpful.

"Have your doctor review both the drugs you're currently taking and the formularies of the two or three plans you may be considering, and ask if there are any options or changes you can make," says Deane Beebe, the communications director of the Medicare Rights Center.

Things to consider when comparing plans:

• Coverage. Check to see whether the plan covers your specific prescription drugs. Medicare plans have a list of drugs covered by the plan that must always meet Medicare's requirements. Even though a particular drug might be on the plan's list, there may be special rules for filling the prescription.

Be aware that a plan's formulary may change during the year because drug therapies change, new drugs are released and new medical information becomes available. If there is a formulary change that affects a drug you take, your plan must notify you at least 60 days in advance. You might then have to change the drug you use or pay more for it. In some cases, you can continue taking the drug you were on until the end of the year. You can also ask for an exception or appeal.

• Cost. Check to see how much your prescription drugs cost in each plan. If you currently have prescription drug coverage, compare your current costs to the costs of the Medicare plans you are considering. Your monthly premiums, deductibles and your share of the cost of each drug (co-payments and/or co-insurance) will vary with each plan. You may be able to pick a plan with or without a monthly premium, yearly deductible or coverage gap.

• Convenience. Make sure the plan's pharmacies include the ones you want to use. Some plans also allow you to get your prescriptions through the mail. And if you spend part of the year in another state, make sure you find a plan that will also cover you there.

Once you find a Medicare drug plan that best suits your medication and financial requirements, join it by either calling the plan or enrolling online.

If you need help comparing plans:

• Go to the Medicare Web site.

• Call 1-800-MEDICARE or 1-800-633-4227. TTY users should call 1-877-486-2048.

• Call your state health insurance assistance program.

Have your Medicare card, a list of your drugs and their dosages, and the name of the pharmacy you use on hand.

This article was reported and written by Kamil Z. Skawinski for Bankrate.com.

Published Jan. 7, 2008

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