Choosing the right Medicare plan: Look beyond premiums

Each year, millions of seniors are able to enroll into a new Medicare prescription drug plan (PDP), and the vast number of available options can make this a daunting task. Choosing a Medicare prescription plan can seem confusing, so the more you know, the easier it will be to find one that makes the most sense for you.

Two of the most important aspects to keep in mind are whether the plan can help the beneficiary save money and protect their health. When searching for the right plan, it’s important to look beyond the monthly premium. To help make the process less overwhelming, ask yourself which features are most important for you. Here are a few to consider:

What is the plan’s CMS Star Quality Rating? Each year, the Centers for Medicare & Medicaid Services (CMS) rates Medicare Part D plans to help you compare the overall quality of plans and make a more informed decision. Based on comments from plan members and other factors, CMS continually “raises the bar” in how they review each plan’s performance in several categories, such as customer service, patient safety, and member experience. Star ratings range from 1 star (poor) to 5 stars (excellent).

Most prescription drug plans receive an average rating of 3.1 stars. In 2011, Medco Medicare Prescription Plan(R) (PDP) earned 4 stars for its national plan and 3.5 stars for its New York plan for overall quality and service. These ratings demonstrate Medco’s commitment to quality and service excellence.

Does the plan tell you when there are lower-cost alternatives available, such as generics? Many brand-name drugs are scheduled to go “off patent” in 2012, which means that there may be new generic medications available. Plans should let you know when these generics are available and will recommend that you connect with your doctor to understand if the generic is appropriate for you.The total cost of a generic drug can be up to 80 percent less than a brand-name drug. By simply asking your doctor if a generic is available, you could save hundreds of dollars and significantly delay reaching the coverage gap – the dollar amount where your coverage runs out until you reach the designated catastrophic level where it kicks back in.

Does the plan offer coverage gap alerts? In 2012, in a standard Medicare prescription plan, once your drug costs (what you pay plus what your plan pays) reach $2,930, you will enter the coverage gap. Choose a plan that gives members the opportunity to learn how close they are to the gap – whether through written materials, phone calls or email alerts – and provides solutions for lowering overall prescription costs that will help to delay entry into it.

Does the plan have online tools? Check into plans that have a suite of online tools for cost comparisons and to ensure safety. Some plans offer tools that alert members when they are taking two medications that don’t work well together and could be potentially harmful to their health.

Does the plan provide access to clinical specialists? Look for a plan that not only provides 24-hour access to in-house Medicare advisors, but also to clinical specialists. They will be best suited to advise beneficiaries on prescription therapies as well as discuss lower-cost options. Finding a plan that includes both Medicare and clinical specialists provides greater value for your healthcare dollar.

Does the plan offer money-saving options? Some plans feature a $0 co-payment for a 90-day supply of generic medications by mail while in the coverage gap, a great way to lower costs during this benefit stage. Access to a mail-order pharmacy allows for the convenience of medications to be delivered directly to the home. Mail order can often provide a three-month supply of medications for nearly 30 percent less than buying a one-month supply three separate times at retail.

Rated 4 stars in 49 states and 3.5 stars in New York for overall quality and service in 2011. Plan performance summary star ratings are assessed each year and may change from one year to the next.

A Medicare-approved Part D sponsor

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