The average monthly Medicare Advantage premium in 2013 is projected to be $32.59, a $1.47 increase over 2012. The average basic Medicare prescription drug plan premium is projected to be $30 in 2013, holding steady from last year.
Drug coverage in the Part D “donut hole,” the temporary gap in prescription coverage that begins after you and your drug plan have spent a certain amount for covered drugs, will increase until 2020, when the donut hole will be closed. Those who reach the donut hole will enjoy a little more savings in 2013 on prescription drug costs. Coverage has gone up from 50 to 52.5 percent for name brand drugs, and from 14 to 21 percent for generics.
Free help to examine Medicare options is available from SHINE volunteers, who help clients compare policies and understand health insurance coverage, said Kathy Sarmiento, a SHINE liaison with the Alliance for Aging in Miami.
There are 28 SHINE volunteers among 10 counseling sites in Miami-Dade and Monroe counties. In Broward, there are 22 volunteers at 14 sites. Counseling sites are listed at FloridaShine.org. Appointments can be made by calling 1-800-96ELDER (1-800-963-5337), or 305-670-6500, ext. 211, in Miami-Dade or 954-745-9779 in Broward.
Last year, 106,000 people in Florida used SHINE services, Gary said.
“We can’t make choices for them or even advise them, but we can say that one plan is better than the other at meeting your needs,” she said. “We can explain benefits and narrow down choices, depending on what’s important to them.”
Here’s a look at what you should review during open enrollment:
The drugs you take
Make a list of the prescription drugs you take, including brand names. Go to www.medicare.gov/find-a-plan and enter your prescriptions to find potential costs: monthly premiums, deductibles and co-payments for plans in your area, as well as national plans.
“Medicare has really been working hard on its website, to make it more user friendly,” Sarmiento said. You can enter just a ZIP Code and your drugs for the coverage information. For more specifics, enter your Medicare number.
If you have Original Medicare, you can check separate stand-alone prescription plans. Medicare Advantage Plans usually include prescription drug coverage, Sarmiento said.
This will not only help you check prices, but also tell you if a plan covers the medicine you take.
“Prescription drug costs can be a major expense in a senior’s life, so if you can change anything to reduce those costs, this is the time to look at it,” Sarmiento said.
Check to see if your plan uses step therapy, which requires patients to use generic drugs before they can get a name brand drug. This also can affect your costs, Sarmiento said.
The doctors you see
Sometimes a doctor will stop accepting a plan, or begin accepting new plans. Check to see if the doctors you like and the hospital you prefer will accept your plan in 2013.
You don’t need to talk to the doctor directly, Sarmiento said. The doctor’s office staff will know.
Think about future needs, said Regine Lemaire, the SHINE liaison in Broward. “For example, an individual might not look at a skilled nursing facility benefit, because they are agile and in good health, she said. “But what happens if you fall and you need home health or a skilled nursing facility?”