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How to use the Medicare Part D Plan Finder

Nobody can pinpoint how much money you will spend on health care next year. It depends on what drugs you take, what doctors and hospitals you use, and what Medicare plan you sign up for. And no matter what television and newspaper ads might claim, no single Medicare plan suits everyone.

But far and away, the best way to choose your 2014 coverage is by consulting Medicare's online Plan Finder. It estimates out-of-pocket costs based on the specific drugs you take. It grades plans by performance. It lets you explore possible pharmacies that can greatly reduce your costs. A good search takes about an hour. If you are not comfortable with computers, try to find someone who is, like Florida's SHINE volunteers at toll-free 1-800-963-5337 or the people who answer Medicare's toll-free hotline at 1-800-633-4227.

But nothing beats do-it-yourself. Here are step-by-step suggestions for working through it.

1 Make a list of all your prescription drugs, along with the dosage and how often you refill them.

TIP: Do not include over-the-counter drugs 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.'' Enter your ZIP code and other information until you get to the page about prescription drugs.

3 Enter your prescription drugs one at a time. The computer may also invite you to switch from a brand-name drug to a cheaper generic equivalent. (If you do switch to the generic, consult your doctor before you sign up with the plan to make sure that is okay.)

TIP: The right side of the screen lists an ID number and password date under "Retrieve My Drug List." Write these down. If you repeat your search later, this ID and password date will pull up your drug list automatically and save time.

When you are done, click on "My Drug List is Complete."

4 Select two pharmacies you might like to use. For now, enter two pharmacies that are likely to offer discounts. If you don't see any you like on this list, a drop-down box at the top allows you widen the distance and see a few more. The temptation is to just use your favorite pharmacies, but eventually you should check out the costs from at least four pharmacies. While that will require you to repeat this part of the search later, it could save you hundreds of dollars.

TIP: This page sometimes measures distance in a quirky fashion. It is possible that a pharmacy just a few blocks from your house will not show up on the list if it lies in a different ZIP code. Keep widening the geographic search until you find it.

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

5 "Refine Your Plan Results.'' This lets you research Prescription Drug Plans that accompany original Medicare, or you can search Medicare Health Plans. Pick however many you want to search.

• Also check out the "Change Health Status'' filter at bottom left. It is preset for people in "good" health. If you are either in poor health or excellent health, 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.

TIP: In general, it is a good idea to avoid filters, because they can skew results and lead you to a more expensive plan.

Click on "Continue to Plan Results."

6 View "Your Plan Results" page. It estimates the cost of various plans tailored to your particular prescription drugs, your health condition and the two pharmacies you picked.

TIP: If you searched for both Prescription Drug Plans and Medicare Health Plans, the drug plans are listed first, then the health plans.

Plans are listed based on your total out-of-pocket costs, including the retail cost of your drugs if a plan does not include them on its formulary:

• Prescription Drug Plans are ranked only on the cost of the drugs, listed in the first column.

• Health plans are ranked by total projected costs, listed in the sixth column. These include premiums, drugs, doctors, hospitals and all other expenses.

TIP: The Plan Results page lists only 10 plans of each type. If you want to see more, click on a blue link under the heading that allows you to "View 20" or "View 50."

7 Print it. Once you set up the Plan Results page to view the number of plans you want to see, print it out. A hard-copy list provides a good place for taking notes and is essential for a thorough search. Don't take the total cost rankings as absolute. You have to dig a little deeper (see accompanying BUYER BEWARE chart), taking notes as you go.

Rx for savings

Congratulations, you're done.

Now do it again. Seriously, it could save you hundreds of dollars — and it will be much easier this time.

Now that you have taken your first swing through the Plan Finder, repeat the process with two new pharmacies.

• Near the top of the Plan Results page, look for the blue links with directional arrows that illustrate your sequence through the Plan Finder. Click on the one that says "Select Your Pharmacies.'' That will take you back to the pharmacy page, where you should pick two new ones that are close to your house and likely to offer discounts. Select them, then click your way back to the "Your Plan Results" page and compare these new findings to the ones listed on the printout from your first search.

TIP: Remember, you may have to click on the name of any plan that interests you to see if the annual drug cost listed on the Plan Results page is actually the cheapest option under that plan.

Time to choose

You've considered:

• Your estimated out-of-pocket costs

• Plan ratings

• Network size

• Out-of-pocket spending caps

Now, 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.

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

The deadline is Dec. 7.

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

What to look for

in plans

Estimated annual drug costs: The first column on the list. This is based on your premium and the drug costs at the two retail pharmacies you selected.

TIP: Note the "Mail Order'' cost listed just below the retail cost. Mail-order purchases 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.

Tricky pharmacy costs: One big flaw in the Plan Finder is that it does not necessarily list annual drug costs based on the cheapest of the two pharmacies you selected.

To work around this flaw, click on the name of any plan that interests you and then on the heading that says "Drug Costs & Coverage." Scroll down until you see the details of your costs at the two pharmacies you selected. Compare those costs to the drug costs listed on the Plan Results page that you printed out and adjust that cost if necessary.

The "Drug Costs & Coverage'' button also has a useful feature down toward the bottom. It lists each plan's network and "preferred" network pharmacies and displays them on a map. "Preferred pharmacies" will usually be the cheapest, but not always. You may want to use the drop-down box at the top of the page to widen the geographic search.

TIP: Here's what could happen if you don't do the work around: In one example, the Plan Finder listed the annual cost of an AARP drug plan as $999 when a Sweetbay pharmacy was selected first and a Walmart pharmacy second. That made the AARP the seventh least expensive plan on the Plan Results page. But when Walmart was selected first and Sweetbay second, the Plan Finder listed the annual cost as $574.32, which made the AARP plan the least expensive of all the plans.

Lower my drug costs: This is a link in the fourth column on the Plan Results page. By following it, you can see how each plan might save you money by switching drugs. It can add up to hundreds of dollars in savings, but check with your doctor before committing to any drug substitution.

Estimated health and drug costs: This is listed in the sixth column on the Plan Results page. (Rebates, if there are any, are included in this calculation.)

National coverage: You can use many drug plans out of state, an important feature for snowbirds. The Plan Results page marks national coverage with a blue "N" icon in the fourth column.

TIP: This designation has been inconsistent in the past. If you are counting on national coverage, double-check with the company before picking a plan.

Overall plan rating: Medicare rates plans on a 5-star system based on customer satisfaction and certain health measures.

TIP: Plans that have performed badly for three years will be marked with a warning sign, which can be important. In 2013, Universal Health Care folded halfway through the year after receiving a warning.

• Icons for health plans: If plans offer coverage for vision, dental or hearing, colorful icons will be placed in the "Health Benefits'' column.

TIP: Take these with a grain of salt until you do more research because these services may be covered but the coverage may be puny.

Individual plan information: If you click on the name of any plan on the Plan Results page, you will get new layers of information. Check these tabs out:

1 "Overview": Look for the provider network size, about halfway down.

Why? Some plans have small networks and that could limit your access to primary doctors, specialists and hospitals.

2 "Health Plan Benefits": Note the "out of pocket spending limit,'' about halfway down.

Why? The lower the spending cap, the better. For HMOs, this cap usually applies only to care received inside the network. Outside the network, your potential costs are unlimited. 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 a specialist of your choice, an out-of-pocket spending limit will cap that cost.)

The benefits tab also lists copayments for various services. Say you know you will spend four days in the hospital next year for elective surgery and a week in nursing home rehab. The copayments for those services under different plans could alter your choice.

How to use the Medicare Part D Plan Finder 10/21/13 [Last modified: Thursday, October 24, 2013 4:56pm]
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