Medicare drug plan enrollment nearing

Oct. 12--John Graham approaches Part D enrollment every year with Medicare expecting prices for prescription coverage to vary widely.

A hospital administrator in the Chicago area before retiring in 2001, Graham compares plan offerings every year since the prescription drug program began in 2006. Part D is for Medicare beneficiaries 65 and older.

"There are 20 different plans you have to navigate," Graham, 74, said. "I shop it because they are always changing."

Open enrollment for Part D plans begins Saturday and runs to Dec. 7 for coverage in 2017

Open enrollment is the time of year when seniors need to consider the prescriptions they are taking and how their current Part D plan may not be best for them next year due to changes in each plan, said Hallie Devlin, coordinator in Collier County and Bonita Springs for Serving Health Insurance Needs of Elders.

SHINE is service offered through the Area Agency on Aging under the Florida Department of Elder Affairs to help seniors with Part D and other medical insurance matters.

Reviewing and potentially switching Part D plans is often a good idea, because insurers retool their approved drug lists, premiums bump up or drop, co-payments change and medications a senior takes often change.

Running comparisons may shave dollars -- often hundreds of dollars -- off total drug spending for the new year, she said.

The nine SHINE volunteers in Southwest Florida can offer one-on-one assistance to seniors to help review options through a series of open enrollment assistance seminars.

In Collier there are 110,000 Medicare beneficiaries and another 12,000 in Bonita Springs, she said.

Last year SHINE volunteers had contact with 1,600 Medicare seniors in Collier during open enrollment.

For help with Part D selection at an event, seniors need to bring a complete list of their medications (or the containers), the dosages and frequency of taking each medication, plus their Medicare insurance card, she said. The seminars operate on a first-come, first-served basis. An individual session takes 20 to 40 minutes.

"For someone comfortable on a computer, they can do it on their own at Medicare.gov," she said.

At a seminar, a SHINE volunteer will plug in details of what medications the senior is taking, and the system will generate a report.

"It gives a comparison of three plans that are most cost-effective," she said.

The comparisons take into consideration premiums, deductibles, co-payments and medications taken, she said. The report will say what month the senior would finish paying a deductible on each of the three plans (if there are deductibles); which month the senior would reach the coverage gap known as the "donut hole" on each of the three plans; and which month the senior would emerge from the coverage gap and enter the "catastrophic" level of coverage, she said.

The numbers-crunching is all done for a senior, and that's a real plus because it can be confusing, said Graham, the retired hospital administrator.

"They take all the complexity out of the equation," Graham said. "They make it easy for you."

Invariably, he switches plans each year. So does his wife, Mary, 71.

"She has a different plan," he said. "Her needs are less."

For 2017 in Florida, there are 20 standalone Part D plans for Medicare seniors, down from 22 standalone plans this year, Devlin said.

There are 18 Medicare Advantage plans with prescription coverage in Collier and 25 in Lee County for 2017, she said.

The Medicare Advantage plans are offered by private insurers with approved provider networks, which seniors need to use for services.

In Southwest Florida, Medicare Advantage plans overall are not popular, because physicians generally don't participate in them and seniors want choice of where to go for care, she said.

For information about Medicare Part D, the government website is www.medicarre.gov. The Area Agency on Aging in Southwest Florida helpline is 1-866-413-5337. Appointments are not possible at Part D open enrollment seminars.

Here are some key changes for next year with standalone plans:

»The average premium is $34 a month next year.

»The deductible (if there is one) will increase to $400 next year, a boost of $40 from 2016.

»The initial coverage limit is $3,700 next year for the individual's drug spending combined with the plan's spending. When that level is reached, the senior enters the "donut hole" coverage gap. The 2016 initial coverage limit is $3,310.

»The "donut hole" coverage gap ends in 2017 when the total spending reaches $4,950. In 2016 the gap ends at $4,850.

»During the "donut hole," seniors will receive a 60 percent discount next year on brand name drugs and a 49 percent discount on generic drugs. This year, seniors receive a 55 percent discount on brand name drugs and 42 percent discount on generic drugs.

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