By Grace-Marie Turner
The holidays are here again. That means it’s time for decorations, gifts, family, friends, and food. But during all the celebrating, seniors enrolled in Medicare Part D should carve out time to consider whether they want to stay with their current prescription drug plan.
At the end of each year, from Nov. 15 through Dec. 31, Medicare Part D provides seniors with an open enrollment period, an easy and convenient way to switch plans or sign up for the first time.
Thanks to the plan’s unique design, seniors can choose from a variety of plans offered by private insurers. Unlike traditional government programs, where there’s just one plan for everyone, Medicare Part D is structured so that insurance companies must compete for customers. Consequently, prices have stayed relatively low while coverage options have flourished.
In fact, some plans cost just a few dollars a month.
That’s why more seniors than ever before have prescription drug coverage. This past year, Medicare Part D provided benefits to almost 24 million people. Meanwhile, polls have indicated that most seniors are happy with their coverage.
This isn’t to say the program has no pitfalls.
Many plans don’t cover every brand-name drug, so members might have to take a generic medication instead of the brand they were using prior to signing up for Part D. Furthermore, for brand-name drugs that still are under patent protection, a generic version won’t even exist. To access these treatments, members might have to pay more out of their own pocket. Or they might have no choice but to take an alternative drug.
So be sure to go over the options carefully, as different plans cover different drugs. And the drugs covered by each plan may change from year to year.
Other problems with Part D include the dreaded “doughnut hole,” or the gap in coverage between moderate and high drug expenses.
By making smart, informed choices, however, seniors can often avoid the hole. In California, for example, Part D enrollees can choose between 14 different plans that offer coverage within the gap. These plans often lowers costs by promoting generics, but at least one of them still covers brand-name drugs.
And paying for the drugs need not be a problem either. All the major drug companies have set up patient assistance programs for senior who need a little extra help paying the bills, even if they don’t qualify for Medicaid.
Eligibility and application procedures vary by company and drug, but doctors can assist patients with understanding how these programs work.
Everyone who uses Medicare should also consider a Medicare Advantage program. About 20 percent of Medicare enrollees currently utilize an Advantage plan, most of which offer “coordinated care” by covering Medicare Parts A, B, and D.
These plans work through private insurance companies in order to combine medical and drug coverage, doing away with the need to deal with separate providers.
The Medicare prescription drug benefit works because it utilizes the choice and flexibility that comes from the private sector.
At the same time, Part D makes purchasing prescription medications safer, freeing seniors from the scary prospect of going online in search of cheap drugs from foreign distributors. With 10 percent of the world’s prescription drug supply now estimated to be counterfeit, it’s extremely dangerous to purchase medicine from fly-by-night Internet pharmacies.
All those seeking drug coverage have a multitude of options to choose from, so there’s no reason to stick with a disappointing plan. Meanwhile, anyone who isn’t covered should take this opportunity to sign up. With all the options that are available, there’s a plan that’s right for everyone. Now’s the time to find it.
Grace-Marie Turner is president of the Galen Institute, a research organization based in Alexandria, Va., that focuses on free-market ideas for health reform.