Turning 65: Taking Care of Prescription Drug Coverage

After 23 years of covering — and giving advice about — Medicare, a veteran journalist wades into the system herself. Part four of a 5-part series.

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If you read parts one, two, and three of this five-part series on entering Medicare, you know that I managed to select a Medigap policy to supplement my basic Medicare coverage — but that I still needed to buy a separate plan to cover prescription drugs.

Spoiler alert: I found this process frustrating and ultimately inconclusive. For background, it’s worth noting that Congress kept the Medicare drug benefit separate to expand the market for private insurers. But with more sellers you get more products — so many that it’s seriously challenging to weigh all the variables and pick the right plan.

I’m hoping that a look at my own frustrations with the process will prepare you to go through it yourself — or at least give you the comfort of knowing that even supposed experts like me (I covered health care and Medicare as a journalist) struggle with this decision.

As a baseline for my decision, I decided to ask my pharmacy about the retail cost of the drugs I currently take. I’ve always had great drug coverage, so it was shocking to learn that my prescriptions would cost $3,131 a year if I had to pay out-of-pocket. (Of course, from interviewing seniors over the years, I know some folks actually pay four or five times that amount.)

(MORE: A Twist in Obama’s Health Care Law)

Then I turned to Medicare’s handbook, Medicare & You, which indicated that I could choose from 33 stand-alone drug plans in New York City. How would I pick one? I started by calling the Medicare Rights Center in New York City, a non-profit organization that I used to serve as a Board Member and that’s supposed to help seniors through this selection morass. Unfortunately, the help I got was disappointing. “How do I make a choice?” I asked the counselor I got on the phone. He asked if I had Internet access and directed me to Medicare.gov. “They will give you a few options,” he said. But how do I choose among those options, I wanted to know. “Make sure the plan covers your most important drugs and of course, the cost of the plan — the monthly premium — may be a factor,” he advised.

I turned back to the handbook for more guidance. Each plan was given a one- to five-star satisfaction rating. That seemed potentially helpful, until I realized that it wasn’t clear what satisfaction meant in this context? Did people complain if they had to pay too much out-of-pocket? Did pharmacies give them a hard time because of restrictions imposed by the insurer? Did they have to wait too long to fill a prescription?

In addition to stars, I had to check the deductibles, co-pays and the monthly premium costs of each plan. Two of the five-star plans had deductibles of $310. Another had a deductible of $100 but a higher premium — a common trade-off. Some four-star plans had lower deductibles. Co-payments ranged from 25 to 33 percent of the drug bill. But the Medicare handbook didn’t say what the co-pays apply to. (A sales brochure from UnitedHealthcare explained that its co-payments would apply to “specialty tier” drugs — unique and very expensive medications. I don’t take any of those now. But I could be diagnosed with a serious new condition in the future, of course.)

(MORE: Medicare Sellers Are After Me!)

Not feeling any closer to a decision, I decided to try the four-step selection tool offered at Medicare.gov. I entered some basic information, listed my three medications and selected the neighborhood pharmacy I use. (Someone who takes lots of drugs could find it frustrating to gather and enter all the dosages and quantities before the website times out.) After a couple of frustrating false starts, it finally recommended a handful of options. Unfortunately, they weren’t the same as the ones in the handbook. The star rankings weren’t the same either. I was growing skeptical.

Even worse, while the “compare plans” section provided a lot of data — monthly premiums, deductibles, co-payments, estimated health and drug costs, and the estimated annual retail cost of my drugs — the costs didn’t match the ones my pharmacy had given me. The pharmacy said my drugs would cost $3,131, but Medicare.gov gave me totals between $1,200 and $1,400.

In the end, I didn’t trust the website information, the help lines weren’t very helpful, and the information in the insurer and government booklets didn’t match. More choices and more information just led to more confusion.

Next week I’ll check out Medicare Advantage plans, which would put my coverage totally in the hands of private insurers, not the government.

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