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Medicare Web site calculates plan costs

The charts published in this issue of LifeTimes can give you a general idea about how different drug and health plans stack up. But the costs of these private insurance plans can vary considerably depending on the drugs you take. The only thorough way to compare costs is with the Medicare Web site, medicare.gov. It allows you to enter your specific drugs and hone in on the cost of individual plans for someone just like you. Computer searching may sound imposing. And indeed, Medicare's Web site is full of details and layers and can be difficult to navigate. This step-by-step guide will tell you how. If you aren't comfortable with computers, try to find a relative or friend to conduct a search for you. A few nonprofit services can also help. A thorough search might take 30 minutes to an hour, but the results will be tailored to your case, and that might save you hundreds, if not thousands, of dollars. After balancing cost, performance, drug restrictions and pharmacy convenience, you can pick a plan that's best for you.

Stand-alone plans

1 Go to www.medicare.gov and click on "Medicare Prescription Drug Plans — 2009 plan data.''

2 Click on "Find & Compare Plans." (Ignore the drop-down box that asks you to select a state.) This page also lets you "View Your Current Plan" for 2008 if you like, but that isn't necessary.

3 Click on "Begin General Search.'' (You can ignore the personalized search function for now.)

4 Enter ZIP code, but skip the boxes where it asks your age and health condition. Answer the other three questions and click on "Continue.''

5 Read this information if you like, or just click on the "Continue'' box on the page.

6 Click on "Enter My Drugs.''

7 Enter your drugs in the box, one at a time. When done, click on "Continue.'' At this point, do not click on "Save My Drug List.''

8 Change the specific doses and frequency of your drugs if the computer fails to list them accurately. Click on "Save My Drug List,'' enter a security password date and click on "Continue.'' This will give you a password number that will enter your drugs automatically if you want to do another search later. Write it down and click on "Continue.''

9The computer will ask if you want to select a specific pharmacy. Answer "No" and click on "Continue.'' If you narrow your search to a specific pharmacy at this point, you may skew the cost results.

10 This is the initial drug plan list, in order of the cheapest plans for someone using your specific drugs. The dollar figures are what you can expect to pay out-of-pocket, including premiums, deductibles and the cost of the drugs. The initial drug plan list is set to show you only five plans at once. Scroll down to the end of the first five plans where small type says it is "Showing Plans 1-5.'' Go just to the right of that and click on "All one page.'' This will allow you to see all plans at once. Print this list so you can take notes. Note the third column that lists the expected cost if you get 90-day mail-order prescriptions. Depending on your drugs, some plans will save you a lot of money through mail-order while others save less. Sometimes the plan that seems the cheapest on the initial plan list is not the cheapest at all if you are willing to use the 90-day mail-order option.

11 Now check out the individual plans that interest you, by clicking on their names, one at a time. This page gives you details for each plan. A bar chart at the bottom of the page shows your month-by-month costs. If your plan has a deductible, the first month or so will be expensive, then your costs will drop as coverage kicks in. If you enter the "coverage gap," the point at which you pay 100 percent of your drug costs — the bar will usually jump dramatically. But if you emerge from the gap and begin "catastrophic'' coverage, the costs will then plummet.

This is for drugs purchased through a retail pharmacy. Underneath this bar chart is a blue line that says "Total Monthly Cost Estimator for Mail Order Pharmacy.'' If you click on the "Show information'' button to the right, you will get a similar bar chart. Note that the costs in the bar chart are higher every third month, when you order your drugs.

12 The top left of the plan details page contains a blue box called "Basic Plan Information.'' Click on "Lower My Cost Share.'' Some plans offer considerable savings if you switch to similar drugs favored by the plan's formulary. Not only can these substitutes reduce your monthly copayments, they usually will delay your entry into the coverage gap as well, because the drug plan is paying less for your drugs at the pharmacy. The "Lower My Cost Share'' box shows how much you can lower your monthly copayments if you buy through a retail pharmacy and accept the plan's substitutes. You can click on the "Similar drug'' or "generic" link to identify the proposed substitute. At the top right of this box, a link gives you the same information if you choose the 90-day mail-order route.

13 These steps will give you a general idea about how you might reduce the cost of individual plans. The only way to pinpoint the plan's exact cost with these drug substitutes is to go to the blue box near the bottom of the page where it says "My Drugs" and make your substitutes, adding and removing as necessary.

This will lead you back to Steps 7 through 9 and then back to the original plan list; note the new, reduced cost for that plan and others now that you are using lower cost drugs. Substituting drugs takes some time but it may be worthwhile after you have narrowed your search down to just a few plans.

A warning: Consult your doctor before picking a plan based on cheaper substitute drugs. Make sure such changes are appropriate for you.

14 Go back to the plan details page for any plan that interests you. Under the Basic Plan Information, click on "View Pharmacy Network.'' A new window will open when you do this. Make sure the plan has a pharmacy you like. Note that you can change the geographic breadth of your pharmacy search.

15 Go back to the plan details page by clicking "close this window" on the Pharmacy List page. Click on "View Important Notes and Benefit Summary.'' Again, a new window will open. This tells whether you can use the plan in other states — important for folks who split their time between two homes.

16 Go back to the plan details page by clicking "close this window." Go down to the fifth blue box marked "Drug Coverage Information.'' This will tell you if the plan places special restrictions on your drugs. "Prior authorization" means your doctor must get approval in advance from the plan before it will cover your drug. This can be a burden. "Quantity limits" means the plan can restrict the number of doses over a period of time. This is usually to make sure you don't overdose, and generally it is not a problem. "Step therapy" means the plan can require you to try a substitute drug before covering your drug of choice. This, too, can be a burden. Evaluate how important any such restrictions are to you. Perhaps a slightly more expensive plan will not have such restrictions.

17 Take a look at the second blue box called Plan Ratings. This is a new feature that was still under development at press time. It is designed to show how users of this plan rate its performance. Medicare hopes to have this information available for most plans by Nov. 15. If not, you might want to check back later before making your final choice.

18 Repeat these steps for any other plans that interest you, then call the plan's nonmember number to enroll.

HMOs, PPOs and Private Fee for Service plans

1Go to www.medicare.gov and click on "Medicare Health Plans — 2009 plan data.''

2 Click on "Find & Compare Plans." (Ignore the drop-down box that asks you to select a state.) This page also lets you "View Your Current Plan" for 2008 if you like, but that isn't necessary.

3Click on "Begin General Search.'' (You can ignore the personalized search function for now.)

4Enter your ZIP code, age range and health status. Fill in other circles as appropriate and click "Continue.''

5Read any of this information you want, though it is not necessary. Then click on "Continue'' at the top or bottom of the page.

6 Click on "Enter My Drugs.''

7 Enter your drugs in the box. When you are done, click on "Continue.'' At this point, do not click on "Save My Drug List.''

8 Change the specific doses and frequency of your drugs if the computer fails to list them accurately. Click on "Save My Drug List,'' enter a security password date and click on "Continue.'' This will give you a password number that will enter your drugs automatically if you want to do another search later. Write it down and click on "Continue.''

9This page asks if you have a preferred pharmacy. Answer "No'' and continue. Answering yes at this point can skew the cost results.

10 This page is the initial list of HMOs, PPOs and Private Fee for Service and Special Needs plans for someone like you. These plans are mixed in together. To distinguish them, the type of plan is listed under its name. The page appears to list the cheapest plans first but that can be deceptive, because it doesn't take into account possible savings within different plans. Print out this page for taking notes so you can dig deeper.

11 Just above the plan list, click on "View Drug Benefits and Quality." This allows you to examine your drug costs in detail for different plans and explore possible savings. When you get to that page, go just above the plan list and to the right, where it says "Sort plans.'' Select "Plan Name and ID Numbers'' from the drop-down box and then click on sort. This will give you an alphabetical list of plans, which makes it easier for you to find the plans that interest you. Now go to just below the list where it says "Showing plans 1-5.'' To the right of that, click on the blue link "All on one page.'' That gives you the full list of plans on one page.

Take a look at the third column, which tells you much you can save if you buy drugs 90 days at a time through a mail-order pharmacy. This can make some plans considerably less expensive. On the printout of plans you made, note these savings for any plan that interest you.

(Note: At press time, Medicare's Web site did not list detailed information about AARP health plans with drug coverage. If that information is still unavailable and you want to consider an AARP plan, check back later on the Web site.)

12 Now check out drug coverage details for the plans that interest you, by clicking on their names, one at a time. A bar chart at the bottom of the page shows your month-by-month costs. If your plan has a deductible, the first month or so will be expensive, then your costs will drop as coverage kicks in. If you enter the "coverage gap," the point at which you pay 100 percent of your drug costs — the bar will usually jump dramatically. But if you emerge from the gap and begin "catastrophic'' coverage, the costs will then plummet. This is for drugs purchased through a retail pharmacy. Underneath this bar chart is a blue line that says "Total Monthly Cost Estimator for Mail Order Pharmacy.'' If you click on the "Show information'' button to the right, you will get a similar bar chart. Note that the costs in the bar chart are higher every third month, when you order your drugs.

13 The top left of the plan details page contains a blue box called "Basic Plan Information.'' Click on "Lower My Cost Share.'' Some plans offer considerable savings if you switch to similar drugs favored by the plan's formulary. Not only can these substitutes reduce your monthly copayments, they usually will delay your entry into the coverage gap as well, because the drug plan is paying less for your drugs at the pharmacy. The "Lower My Cost Share'' box shows how much you can lower your monthly copayments if you buy through a retail pharmacy and accept the plan's substitutes. You can click on the "Similar drug'' or "generic" link to identify the proposed substitute. At the top right of this box, a link gives you the same information if you choose the 90-day mail-order route.

14 These steps will give you a general idea about how you might reduce the cost of individual plans. The only way to pinpoint the plan's exact cost with these drug substitutes is to click on "Return to Personalized Page Plan List," scroll to the bottom and make the drug substitutions in the blue box where it says "My Drugs," adding and removing as necessary. This will lead you back to Steps 7 through 9 and then to the original plan list; note the new, reduced cost for that plan.

Substituting drugs takes some time but it may be worthwhile after you have narrowed your search down to just a few plans.

Warning: Consult your doctor before picking a plan based on cheaper substitute drugs. Make sure such changes are appropriate for you.

15 Go back to the plan details page. Under the Basic Plan Information, click on "View Pharmacy Network.'' A new window will open when you do this. Make sure the plan has a pharmacy you like. Note that you can change the geographic breadth of your pharmacy search.

16 Go back to the plan details page by clicking "close this window" on the Pharmacy List page. Click on "View Important Notes and Benefit Summary.'' Again, a new window will open. This tells whether you can use the plan in other states — important for folks who split their time between two homes.

17 Go back to the plan details page by clicking "close this window." Go down to the fifth blue box marked "Drug Coverage Information.'' This will tell you if the plan places special restrictions on your drugs. "Prior authorization" means your doctor must get approval in advance from the plan before it will cover your drug. This can be a burden. "Quantity limits" means the plan can restrict the number of doses over a period of time. This is usually to make sure you don't overdose, and generally it is not a problem. "Step therapy" means the plan can require you to try a substitute drug before covering your drug of choice. This, too, can be a burden. Evaluate how important any such restrictions are to you. Perhaps a slightly more expensive plan will not have such restrictions.

18 Take a look at the second blue box called Plan Ratings. This is a new feature that was still under development at press time. It is designed to show how users of this plan rate its performance. Medicare hopes to have this information available for most plans by Nov. 15. If not, you might want to check back later before making your final choice.

19 Now it's time to explore other aspects of the PPO, HMO and Private Fee for Service plans. At the top of the plan's drug details page, click on the blue link that says "Back to Choose Plans and Compare.'' On the next page, click on "View Health Benefits and Quality,'' which is just above the plan list.

20 When you return to the "Find and Compare Plans'' list, use the selection boxes at the left of each plan to choose three plans that interest you. Scroll to the top of the list and click on the button that says "Compare Health Benefits.'' (Remember: HMOs, PPOs and PFFS plans are mixed together on the initial list. Make sure you pick the types of plans you want.)

21 This is a grab-bag of plan details, including out-of-pocket spending limits, whether the plan lets you get treatment out-of-network and how the plan handles dental, vision and hearing aid coverage. The page gives an estimated cost for each plan for someone like you, but that can vary quite a bit depending on your circumstances. For example, if you foresee a lot of hospitalization, play close attention to inpatient copayments, which can vary widely between plans. For HMOs, PPOs and Special Needs plans, note the second item down, "provider network.'' Some plans have very small networks, a concern if you are worried about choice. A link will let you view the doctors and hospitals in a plan's network. The "View Plan Details'' option under each plan gives even more information.

22 Go to the right of the page, under the green "Learn More'' button. Click on "Find out why people have left these plans.'' At the top left of the next page, hit the "Show All'' button, then examine the tables. Some plans have poor track records for giving you the doctors and care you want. When you are done, close the window.

23 To view more plans, go to the top left of the 3-plan comparison page and click on "Back to Step 4, Choose plans to compare.'' Select up to three more plans and repeat this process, taking notes as you go.

24 After balancing all the information you have gathered, pick the plan that suits you best and telephone the company to enroll.

Stephen Nohlgren can be reached at nohlgren@sptimes.com or (727) 893-8442.

Medicare Web site calculates plan costs 10/27/08 [Last modified: Wednesday, October 29, 2008 7:40pm]

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