 | Steve Henry is the owner of Liberty Benefit Plans, located at 510 N Topeka in Wichita. An agency for Health and life insurance products. Representing top name companies like Mutual of Omaha, AFLAC, AIG and many others for Health, Life, Medicare Supplement Insurance. Steve can be reached at (316) 686-5433 or libertybenefit@cox.net |
Insurance
2005-12-29 10:45:00
Part D Medicare Rx?
: Part D Medicare Prescription drug coverage is so confusing, how am I supposed to know which one to pick?
ANSWER: When Medicare reform legislation was signed into law by President Bush in 2003; it ushered in some of the most significant changes to the Medicare program since its inception. The basic goal of these changes was to provide expanded health coverage choices for those eligible for Medicare and try to address the prescription drug needs of many Medicare-eligible Americans.One of those changes-the new Medicare Part D benefits-directly targets the prescription drug issue. The Medicare Part D plans provide insurance coverage for prescription drugs. Medicare beneficiaries may purchase the Part D plan available in their area through a private insurance company; those who buy a plan will pay monthly premiums and a co-payment or coinsurance for each prescription filled. These costs will vary based on the Part D plan chosen.A COMPLEX PLANThe Government came up with a simple plan or model and let the insurance companies design a plan around this basic model. Some of the basic features of the Medicare model plan:• A monthly premium (estimated to be about $35)• $250 annual deductible• The Medicare beneficiary pays a 25 % coinsurance for all expenditures between $251 and $2,250• The beneficiary pays 100 percent for all expenditures between $2,250 and $5,100• The beneficiary pays the greater of 5 percent coinsurance or $2 for generic drugs and $5 for brand name drugs for expenditures above a $3,600 annual out- of-pocket threshold. (The thresholds will increase annually, based on average expenditures.)Private insurance companies have designed their plans to add to this, which is confusing. There are at least 15 companies in Kansas with over 40 different plans from which to choose. This variety makes it all the more important for you carefully examine your options. The best way to make sure you pick the right plan is to sit down with a Medicare "Certified" insurance agent to evaluate your prescription drug needs and the costs and benefits available under Medicare Part D plans available in Kansas. An agent can help you determine what makes the most sense for you and your situation. The agent usually gets paid a small flat fee to help you make a choice. There is no motivation for the agent to oversell you on anything. Important things to consider when purchasing a plan;1. Are your drugs in the plan's formulary? (Circle the drugs names on the formulary list and note the tier and co-pay for each.)2. What is the deductible, if any?3. What is the premium?4. How does the plan's coverage of your drugs change as your prescription drug costs add up throughout the year?5. What the total amount you would pay with and without a Medicare drug plan?Final considerationsDo you have enough information to make a decision? Are you comfortable with your decision?There is no doubt that this is all confusing, if you haven't made a decision yet, you are in good company. Don't rush a decision until you feel certain it will help you. The current open enrollment lasts until May 15, 2006, without any penalty.If you are still have questions, ask for help.
