Medicare Drug Plan, A Primer
by Barbara C. Phillips, NP

On a daily basis questions, I receive more questions about the Medicare Drug Plan (Medicare Part D) than any other insurance questions. No…I’m not an insurance agent, but a primary health care provider. I’ll let you in on a secret – many of us are just as confused as everyone else.

With that in mind, I felt it was time to do a bit of homework.

The intended benefit of the plan is to provide a more affordable away for seniors to obtain medications. I think one of the confusions about it is its tiered approach.

While there is a standard plan, companies may offer something somewhat different. Here is what the standard plan consist of. (*Your plan may vary from this in cost and benefit).

• Yearly annual deductible of $250.00
• Monthly premium for the plan you choose. Estimates are averaging $32.00
• Co-pay in Tier 1
• 25% for covered medications after you meet your deductible, up to $2,250. For example, every time you pick up medications, you pay 25% of the cost of medication after you meet your deductible, and up until you spend $2,250 dollar (per calendar year).
• Co-pay in Tier 2
• Your cost from $2,250 and up to $5,100 are yours 100%. In other words, once your cost of medications has reached $2,251, you will pay 100% of the cost of medications until you hit the out of pocket threshold of $5,100.
• Co-pay in Tier 3
• After you have hit the out of pocket threshold, your co-pay will be $2.00-$5.00 per prescription (generic vs brand name) or 5% of the cost of the covered drug (whichever is greater) for the rest of the year.

Each company that is offering a plan will have some slight variation of this. They can have a deductible that is lower, your co-pay higher, etc. In addition, depending on your income level, there may be plans you qualify for where your out of pocket expenses are greatly reduced.

Keep in mind that your plan will vary even within the same company. Earlier this year, I recently reviewed my Mothers plan with Kaiser of Southern California. When she moved to Northern California, her benefits changed in regards to monthly premiums, co-pays and what medications were covered. Take heed and investigate before switching.

Where can you get more information?

• Medicare
• AARP
• Your individual insurance company
• Your specific state Dept of Social and Health Services (DSHS).
  For example, here is the one for WA State

I doubt it will get any less confusing; however, it's important that you make a choice before the deadline of May 15, 2006 as penalties will apply.

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©2006, Barbara C. Phillips, NP is board certified in both Family and Geriatric health care and provides primary care to all ages. She is the founder of OlderWiserWomen and HealthyAgingForWomen. Receive your free copy of “Celebrating You: 50 Tips for Vibrant Living with your free membership at www.OlderWiserWomen.com

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