The charts in this special report are designed to give you partial information on Medicare plans. But they are only a general guideline and are not tailored to your individual circumstances.
The Plan Finder function on Medicare's website, however, offers a wealth of information based on the specific drugs you take and your general health conditions. It helps you make a true cost comparison between different plans.
Some people, for example, pick a plan because it rebates their Part B premium and appears to have low copayments. But, in fact, those plans can turn out to be more expensive if coverage is skimpier than with plans that charge premiums.
Here's a step-by-step guide for using Medicare's Plan Finder. It will take you at least an hour. If you aren't comfortable with computers, try to find a family member or friend who can help.
1. Make a list of all your prescription drugs, along with the dosage and how often you refill them.
2. Go to www.medicare.gov and click on the button that says "Compare Drug and Health Plans."
3. Enter your ZIP code in the "General Search" box and click on "Find Plans." You can do a "personalized search,'' which will make it easier to compare your current coverage with next year's coverage, but it is not necessary.
4. Enter your information on this page and hit "Continue."
5. Enter your prescription drugs, one at a time. Note that the computer will urge you to substitute generics for brand name drugs. This is a good idea if your doctor approves, but it is not necessary. Later, you will get a chance to see how much you can save by switching to the generic. The website calculates costs based on 30-day supplies. Leave it that way, even if you receive your drugs every 90 days. That will give you the best cost estimate in the results, even though you continue buying the drugs every 90 days. When you finish, click on "My Drug List is Complete."
6. On the next page, pick the pharmacy you prefer. Later, you may want to switch pharmacies to save money, but the initial results will be based on you using your preferred pharmacy. The list contains pharmacies within a half-mile of your ZIP code. If you prefer a pharmacy outside that zone, the box located above the list allows you to widen the search. Continue to next page.
7. Under "Summary of Search Results," designate the types of plans you want to research — prescription drug plans, health plans or both. If you want to compare estimated costs between original Medicare and a Medicare Advantage health plan, check both the prescription drug plan box and the health plan box. To the left are buttons that let you refine your search. The default search setting is for a person in "good'' health. If your status is either "poor'' or "excellent,'' click the "Change Health Status" button and make that change. Remember what health status you are using during this search.
It's generally a bad idea to use the other search refining buttons at this point because they could skew the cost results. One possible exception is "Special Needs Plans," which can be useful for people on Medicaid, people with chronic diseases, including diabetes and COPD, as well as for permanent residents of nursing homes. If one of those applies to you, hit the "Select Special Needs Plans" button, mark your condition and "Update Plan Results." When you are done with this page, hit "Continue to Plan Results."
8. This is the "Your Plan Results" page, which estimates the cost of each plan, based on your drugs and health status. Note that if you chose to research prescription drug plans as well as health plans, they are grouped together by type of plan and not intermingled. At the top of the page, you will find information about original Medicare, as if you used it with no further coverage. If you entered your current plan earlier in the search, it will also appear at the top for comparison purposes. Otherwise, the plans are listed according to your expected cost, from least expensive to most expensive.
9. The results page is designed to list the 10 cheapest plans in each group. But you may wish to examine more plans, particularly if you want to deal with a particular company or research a specific plan. Above each group is a button that allows you to "View 20" or "View 50.'' Click on those if you want to expand the list. Print this page as a record, and to make notes. You may need to generate a new results page after switching drugs or pharmacies. By keeping a printout, you can tell at a glance how different choices affect cost.
Here are things to look for:
A) Estimated annual drug cost: The first column on the left of each plan lists your expected out-of-pocket costs for drugs. Above the dollar figure is "pharmacy status.'' This tells you whether the pharmacy you selected earlier is in the plan's network. If the list says "network'' or "preferred-network,'' then the cost estimate should be reliable. If the list says "out-of-network,'' then you can often cut the costs of this plan substantially by switching to a pharmacy on its network. You can identify in-network pharmacies later in your search. There is almost always one near your home.
B) Estimated health and drug costs combined: The website makes this calculation for health plans with drugs. It is in the second column from the right. If your plan rebates part of your Part B premium, that rebate has been subtracted from your total cost.
If you want to use original Medicare in tandem with a prescription drug plan, you face a little math to come up with your total out-of-pocket cost. The entry at the top of the results page that says Original Medicare estimates your combined health and drug costs, also in the second column from the right. But that figure is deceptive because it presumes you have no drug plan and will pay retail prices for your drugs. Your actual costs can be much lower if you add a prescription drug plan.
Look at the various prescription drug plans on the results page and note the estimated out-of-pocket cost for your drugs under any plan you like. Then add in Medicare's estimated cost for health coverage (doctors, hospitals, nursing homes, etc.). If you listed your health status as "good'' earlier in the search, add $3,200. If you listed you health status as "excellent'' add $2,600. If you listed your health is "poor,'' add $4,450. The sum of these estimated health costs and estimated drug costs with a prescription drug plan now gives you an apples-to-apples cost comparison between original Medicare and health plans that cover drugs. Depending on your health condition and the drugs you take, original Medicare may be quite competitive with many Medicare Advantage health plans.
C) Overall plan rating: Medicare rates plan performance on a 1- to 5-star basis. Most plans in the Tampa Bay area range from 2.5 to 4 stars, so these differences can be small. Pay attention if you see a "Warning'' sign in this column. That means a plan has rated low for three years in a row.
D) Monthly premiums, deductibles and copayments: These can be interesting, but keep in mind that they are included in Medicare's estimate for your total out-of-pocket costs.
E) Icons for health plans: Medicare has added colorful icons to show if health plans include any kind of vision, dental or hearing coverage. Keep in mind that a plan can earn this icon even if its coverage is minimal.
F) Blue "Lower Your Drug Costs'' link: If you click here, you can follow the instructions to see how much you can lower the costs of each plan by swapping out your drugs for cheaper but comparable ones, often switching a generic for a brand-name drug. This function is a little unwieldy. Click on "click to calculate savings'' next to any drug, which shows how much a cheaper substitute drug will cost. If you want to view possible savings on another drug, go to the top of the page and click on "Return to previous page,'' then repeat the process with the next drug. If you click on the "click here to review savings'' button next to a drug name and then click "Yes, you want to replace the drug,'' all that will do is switch the cheaper drug for the more expensive one back on the page where you entered your drugs. To see how the substitute drug will affect the cost of different plans, you will have to restart the search from the "Enter My Drugs" page and generate a new results page. Do not count on switching drugs without consulting your doctor first.
G) Individual plan information: If you click on the name of any plan on the results page, you will get new screen levels for that plan. It is a good idea to check these before making your final selection. You will see tabs for an "Overview," "Health Plan Benefits," "Drug Costs & Coverage" and "Plan Ratings."
The "Plan Ratings" tab contains interesting information about customer satisfaction and how each plan has performed. The "Drug Costs" lets you see how much you can save by getting your drugs through a mail service. It also lists network pharmacies if the one you selected is not in the network. Look for the blue link near the bottom of the page. If you like this plan, you can probably lower its cost by switching to a network pharmacy. Pick one and go back to the pharmacy page on your original search, put in the new pharmacy and regenerate a new results page.
The "Health Benefits" page includes a line about your out-of-pocket spending limit, which can be important if you have surgery or a serious illness during the year. The lower the cap, the better. Some PPOs also cap your out-of-pocket spending when you go outside their network.
H) Compare boxes: The results page has a white box next to each plan name. You can click on up to three of these boxes and then hit the orange "Compare Plans" button that precedes each list of plans. That will let you see details of up to three plans, side by side.
10. Consider recalculating results. If you listed several brand name drugs that have generic substitutes, it is probably a good idea to return to the "Enter Your Drugs" page, switch to those generics and generate a new results page. It might substantially change which plans are the least expensive. Again, consult your doctor about whether you can switch drugs before your rely on that for your plan choice.
11. Pick a plan. After considering your estimated out-of-pocket costs, possible savings by switching drugs, plan ratings and any other information (like a company you feel you can trust), pick a plan. You can enroll by contacting the plan directly, by calling 1-800-MEDICARE, or by going to the results page and clicking on the "Enroll Now'' button to the right of the plan.