Taking a look at the 2016 Medicare premiums

Taking a look at the 2016 Medicare premiums

What are the cost variables for the 2016 Medicare Part D drug plans such as premiums, deductibles, gap, etc.? With so many variables, what is the best method for determining the best Part D drug plan for 2016?

Premium is the cost you must pay every month to carry the Part D insurance. The 2016 the premium costs (in Maryland) will range from a low of $18.40/month to a high of $87.10/month.

Some Part D plans have a deductible. A deductible is an amount that you must pay for your medicines before a Part D drug plan will begin covering them. The maximum deductible will be $360 for 2016.

Once you meet the deductible, your Part D drug plan will help cover the cost of your medicines. Some Medicare Part D drug plans will not impose a deductible.

The next phase of Medicare Part D is called the initial coverage limit - during this phase, your drug plan will pay the majority of the cost of your medicines. During this phase, your Part D drug plan will pay approximately 75 percent of the cost of your medicines; you will be responsible for co-pays that average approximately 25 percent of the cost of your medicines.

Your drug plan will be monitoring the cumulative cost of your medicines - when the cost of your medicines (the portion the plans pays plus your co-pays) reaches $3,310, you enter the coverage gap.

The coverage gap is commonly called the doughnut hole. If you enter the coverage gap, you have to pay 42 percent of the cost of your brand-name medicines. You will remain in the coverage gap until one of two things happen: either the calendar year ends and you begin a new initial coverage limit, or the cumulative cost of your medicines exceeds $7,062.50 and you enter catastrophic coverage.

Catastrophic coverage is the "other side of the gap." It simply means that the drug costs, for the calendar year, have been so high that the Part D drug plan will now cover almost all the cost of the medicines for the remainder of the year.

For 2016, there will be over 20 different Part D plans available. The Medicare Part D open enrollment begins Oct. 15 and ends Dec. 7. During this time period, you may visit www.medicare.gov and use the Medicare Plan Finder tool to evaluate your Part D options.

You simply enter the medicines you are prescribed and your pharmacy preference; you may also request that the Plan Finder evaluate plans based on such data as the customer service rating, mail order costs or other factors important to you. The Plan Finder calculates all the above cost variables and other preferences you select, providing you a list of the most cost-effective Part D plans for you.

You may enroll online using the Medicare Plan Finder. If you do not use a computer, you may call 1-800-MEDICARE and request a Medicare Part D comparison. A Medicare representative may enroll you over the phone into a Medicare Part D drug plan.

If you enroll into a Part D drug plan during the Oct. 15-Dec. 7 open enrollment period, your effective date for your 2016 Part D drug plan will be Jan. 1, 2016.

Amy Rubino is director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging and Disabilities. You may contact either program at 410-222-4464 or [email protected].

Covering

The Bases

Amy Rubino