Trying to determine which Medicare drug or health plan best meets your needs can be confusing. These tips can point you in the right direction.
1. Go to the official Medicare website, www.medicare.gov
2. Press the Find Health & Drug Plans button on the left side of the next page. You can also review an online tutorial on how to use the plan finder on this page. It helps!
3. On the next page you can perform a General Search by only submitting your zip code. You then press the next few buttons in regards to having a Medicare supplemental health plan, other types of coverage or if you receive any financial assistance towards your plan costs. Be careful. You can also perform a Personalized Search by adding your zip code, your Medicare number, your last name, your Medicare effective date and your date of birth. This search will offer more personalized feedback on the screen.
4. On the next page, enter your drugs one at a time, including the correct dosage. If you are not sure of the spelling of a drug you can use the alphabetic listing provided. This is where you can also indicate if you can use a generic version of a brand name drug.
5. A list of the drugs you entered will appear. Carefully review each one to make sure that the dosage listed next to the medication is the dosage that you are prescribed. If not, press on the change dose box and select the correct dose (e.g. many medications can either be 10 or 20 mg per tablet). Check the frequency (e.g. 30 or 60 pills monthly).
6. After listing all of your drugs press the My Drug List is Complete Button. At this point you may want to make any changes to the automated Save Your Drug List feature on the right side of the page. The system automatically saves your entered drug list in case you need to make any changes to your list in the future.
7. You next will be asked to choose a pharmacy. You need to choose one now to be able to continue your search. Once you reach the actual plans you may decide to switch pharmacies if you identify one that is a preferred pharmacy and might save you some additional money on the cost of your drugs. Press the Continue to Plan Results button.
8. On the Refine Your Plan Results page select the type of plan you are seeking, either a Prescription Drug Plan or a Medicare Health Plan. Press the Continue to Plan Results button. Remember that a Medicare Health Plan covers all medical needs, not just drugs.
9. Choose up to three plans to compare and review. If you are searching for Medicare Advantage plans please be sure to understand their coverage limitations on available providers, such as physicians or hospitals, and any drug usage restrictions.
10. You should sort your results by the lowest estimated annual drug costs when doing a search during the annual election period. If doing a search at any other time of year you should check the drop down box for a feature that allows you to sort the plans by the lowest estimated cost for only the remaining months of the calendar year.
11. When reviewing each plan, be sure to check to see if the plan has any important utilization restrictions, such as prior authorization, quantity limits or step therapy (in which drug therapy for a medical condition always has to begin with the most cost-effective therapy, such as using generic drugs, and only includes more costly medications if deemed medically necessary). This data is found on the 4th column of the Plan Results page. It may be worth spending a few more dollars each month on a premium to avoid some of the restrictions; otherwise you may need to have your physician assist you with writing a letter to the plan to overcome any restrictions noted.
12. If you have any questions try calling the drug plan using their toll-free phone number; call Medicare at 1-800-633-4227; or talk to a Virginia Insurance Counseling and Assistance Program (VICAP) counselor. VICAP is a counseling program to assist your understanding of Medicare. There is no cost for this service. Call the Department for Aging and Rehabilitative Services, Virginia Division for Aging (DARS) toll-free at 1-800-552-3402 to find a local VICAP program.
13. When you have all of your questions answered and have found the plan that best fits your current needs, enroll either online or by phone. It is important to complete your enrollment during the annual enrollment period (October 15 - December 7). The new prescription benefit plan will be effective on January 1. Individuals newly qualified for Medicare will be asked to choose a prescription benefit plan when they first become eligible for benefits during their Initial Enrollment Period.
Howard Houghton is a Virginia Insurance Counseling Assistance Program(VICAP) representative at Valley Program for Aging Services(VPAS)