A step-by-step guide to Medicare's Plan Finder to pick Part D drug plan

So many choices.

The stories and charts in this special section can give you a general guide to picking a Medicare plan for 2013.

But there's only one way to do it thoroughly: You have to use the Plan Finder on Medicare's website, searching plans that are tailored to your specific prescription drugs and needs.

If you are not comfortable with computers, try to find someone who is. The people who answer Medicare's 1-800-633-4227 toll-free hotline can help a little.

SHINE volunteers, who work for the state of Florida, can help some. But the key to maximizing your coverage is to work through the computer yourself or with a friend or relative. You can usually save hundreds of dollars and get better coverage to boot.

Here is a step-by-step guide on how to do it. It probably will take about an hour.

1 Make a list of all your prescription drugs, along with the dosage, how often you refill them and whether you buy them at a pharmacy or through mail order. You will need this list for Step 5. Do not include over-the-counter drugs, which are not listed on the Plan Finder because Medicare does not cover them.

2 Go to medicare.gov and click on the yellow button near the top that says "Find health & drug plans.''

3 Enter your ZIP code on the "Medicare Plan Finder" page and click on "Find Plans.''

4 Enter some personal information on this page and click on "Continue to Plan Results.''

5 Enter your prescription drugs one at a time. The computer will ask you to verify the dosage, quantity, frequency of refills and whether you buy the drug through a pharmacy or mail order service.

It may also invite you to switch from a brand-name drug to a generic equivalent. This can lower your cost substantially.

You can continue your search based on a brand name you are currently taking, or accept the switch and list the generic instead. But don't actually sign up for a plan unless your doctor approves any switch.

Note the Retrieve My Drug List on the right of the screen.

It gives you an ID number and password, which is a date. Write those down. If you have to come back to this step later, using the ID and password to retrieve your list can save a lot of time.

6 Select two pharmacies near your house. The list includes pharmacies within half a mile of your ZIP code. If the pharmacy you typically use is farther away, click the arrow next to 0.5 miles at the top of the green box. It will allow you to search up to 4.5 miles away.

After you have picked two pharmacies, click on "Continue to Plan Results.''

7 Under "Refine Your Plan Results,'' select the types of plans you want to research — prescription drug plans (which accompany traditional Medicare), health plans that include drugs, or both.

The list on the left offers several filters. The "Change Health Status'' filter is set for people in "good" health. If you are either in poor health or excellent health, click on that button and make that change.

The filter for "Select Special Needs Plans'' is only for people with certain chronic diseases like diabetes or COPD, people in nursing homes or people who also qualify for Medicaid.

These plans sometimes offer a better price or richer services than regular plans do, but consult the company carefully before signing up for a special needs plan to make sure you qualify.

The "Select Coverage Options'' filter can be useful if you travel a lot. It lets you restrict your search to plans with nationwide coverage. In general, though, it is best to avoid activating too many filters because you may end up eliminating a plan that is otherwise a good fit and could save you money.

When you are finished with the filters, click on "Continue to Plan Results."

8 This is the "Your Plan Results" page, which estimates the cost of various plans tailored to your particular prescription drugs and health condition.

Note that if you searched for both Prescription Drug Plans that accompany traditional Medicare and private Medicare Health Plans with drug coverage, the drug plans will be listed first, then the health plans.

9 Plans are listed, beginning with least expensive, based on your total out-of-pocket costs for all drugs, both those on the plan's formulary and any for which you might have to pay retail because the plan doesn't cover them.

For Prescription Drug Plans, cost is based only on the cost of the drugs because there are no other benefits. Health plans are ranked by total costs, including drugs and all other expenses.

10 Note that the plan results page is set to list only 10 plans of each type.

It does not contain a "next" button at the bottom that would lead you to the second group of 10.

If you want to look at more than 10 plans, click on a blue link under the heading that allows you to "View 20, "View 50" or "View All," which will appear if there are more than 50 plans.

11 Once you set up the results page to view the number of plans you want to see, print it out. A hard-copy list makes a good place for taking notes. Medicare's 1-800-number employees and advocates who help people pick plans over the telephone typically just tell you about the first three plans of the type you are seeking. But that can be a mistake. A plan listed first — as if it were the least expensive — may be less competitive when you dig deeper. Likewise, a plan ranked fifth or eighth or even 10th could actually be the cheapest upon closer inspection.

What to look for in plans

To evaluate plans, here are things to look for:

A) Estimated annual drug cost: The first column on the list. This is based on buying the drugs at the two retail pharmacies you selected. Note the "Mail order'' cost listed just under the retail cost. Mail order purchase can save you more than $300 a year with some plans, but only a few dollars with other plans. If you agree to buy your drugs through mail order, use that cost. (Remember, the estimated annual cost also includes drugs not covered under the plan that you have to pay for yourself.)

B) Pharmacy status: If cost savings is the top priority, it is usually sufficient to research the first 10 or so plans to find the cheapest one — with one caveat. Make sure at least one of your pharmacies is covered under their plan.

In the first column, the "Pharmacy Status" should be "Network" or "Preferred network.'' If it says "Out of network,'' that could dramatically increase the cost of that plan.

To find a plan's pharmacy network, click on the name of the plan, then the "Drug Costs & Coverage'' button.

Near the bottom of that page is a category called "Pharmacy & Mail Order Information." Within that category is a link in blue to "Network Pharmacies." Click on that to see what pharmacies in your area are in the plan. Pick two and go back to the "Select Your Pharmacies" page and change to network pharmacies.

C) Estimated health and drug costs combined: For health plans, this is easy — it's listed in the third column from the right.

Note that any premium rebates are already included in this calculation. For drug plans, you must do a little math to derive total estimated health and drug costs.

Take the estimated annual drug costs, then add in Medicare's calculation for your out-of-pocket health costs under traditional Medicare. That is $2,427 for a person in excellent health, $3,027 for someone in good health and $5,077 for someone in poor health.

This process gives you a rough apples-to-apples cost comparison between traditional Medicare and health plans under Medicare Advantage.

Health plans are usually less expensive, but they limit your choice of doctors, hospitals and other providers.

D) National coverage: You can use many plans out of state. The "Your Plan Results" page appears to mark this feature clearly for drug plans with a blue "N" icon in the fourth column.

But at press time, the Plan Finder contained inconsistencies that called the accuracy of the blue icon into question. If nationwide drug coverage is important to you, double-check with individual companies about their plan's provisions.

For health plans with drug coverage, you must click on the name of each plan, and look under the Overview tab for the "important note" about halfway down.

E) Overall plan rating: Medicare rates plans on a 5-star system based on customer satisfaction, located in the second column from the right. Plans that have performed badly for three years or more will be marked with a warning sign.

F) Icons for health plans: Under the "Health Benefits'' column for each plan, you will see colorful icons for vision, dental and hearing coverage. Plans can earn such icons with puny actual coverage, so take them with a grain of salt.

G) Individual plan information: If you click on the name of any plan on the "Your Plan Results" page, you will get new layers of information. Check these out for any plan you are considering.

Under the "Overview" tab, look for the provider network size, about halfway down. Some plans have small networks and that could limit your access to primary doctors, specialists and hospitals.

Under the "Health Plan Benefits" tab, note the "out of pocket spending limit,'' about halfway down. These range from $3,200 to $6,700 in the network. The lower the spending cap, the better.

Some PPO health plans have out-of-network spending caps as well. This can be a great benefit. (For instance, if you get cancer and want to go to an out-of-network specialist, an out-of-pocket spending limit will cap that cost. Otherwise, you might not be able to afford to go where you want.)

Under the "Drug Costs & Coverage" tab, a neat graphic toward the bottom shows how much you will pay for drugs each month.

H) Compare plan details side by side by checking up to three boxes next to the plan names on the "Your Plan Results" page.

I) Pick a plan: After considering your estimated out-of-pocket costs, plan ratings, network size, out-of-pocket spending caps and any other information (like a company you can trust), pick a plan.

You can enroll by contacting the plan directly, by calling toll-free 1-800-633-4227 or by going to the "Your Plan Results" page and clicking on the "Enroll Now'' button to the right of the plan.

Before you pick a health plan, remember to first make sure your current doctors are in the network.

J) Snowbird alert: One shortcoming of the Plan Finder is that it does not tell you which health plans might have useful provisions for people who live part of the year in other states, or for people who travel a lot.

For example, Humana has a PPO plan that allows you to seek treatment for a higher price outside its Tampa Bay area network. That's how PPOs work.

But if that treatment comes from a provider in a Humana network somewhere else in the country, the PPO member still only pays the in-network price. In effect, Humana provides a nationwide network for PPO members.

This reciprocity does not apply to HMO members. To get coverage, they must stick to their local network for treatment, except in emergencies. Consult individual plans directly for information about out-of-state health coverage.

And remember: The deadline for picking is Dec. 7.

A step-by-step guide to Medicare's Plan Finder to pick Part D drug plan 10/24/12 [Last modified: Wednesday, October 24, 2012 2:31pm]

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