Figuring out Medicare drug plan is no easy task - East Valley Tribune: Health

Figuring out Medicare drug plan is no easy task

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Posted: Wednesday, February 15, 2006 1:16 pm | Updated: 2:23 pm, Fri Oct 7, 2011.

Larry Glass, 72, understands the continued confusion over the new Medicare prescription drug plan that became effective Jan. 1.

“One of the problems we had was knowing where to start,” the retired pharmacist said of himself and wife Jan, 68.

The government-administered Medicare Part D plan is designed to help seniors with prescription costs, which have jumped faster than inflation over the past decade, but critics of the program say it is too complex, with too many choices. In Arizona alone there are 45 different private insurance companies offering 86 different Medicare Part D plans — each with a different pay

structure.

The Glasses’ starting point turned out to be their pharmacy, where an AARP representative had been posted to answer questions.

“The most important piece of information I got from her was a phone number,” Glass said: The one for AARP’s toll-free number for questions about Part D and the AARP’s version of the plan.

At home, the couple downloaded the retirement group’s complete drug formulary — the list of covered medications, along with the amount of co-pay for each — and began figuring costs. Then they checked a few other plans.

“You can’t check them all. There are just too many,” Glass said. “I’d recommend checking four, maybe five at the most.”

At best the formularies are cumbersome. At worst, they are downright frustrating. But Glass, unlike many senior citizens, is computer-savvy, and a computer can be an important tool in retrieving information about the plans.

He also knows the names of each of his medications, but he knows that’s not always the case: When he was behind the pharmacy counter, it was common for his older customers to refer to a prescription only as “that little blue pill.”

In the end, the Glasses decided the AARP plan made the most sense — and savings — for them. Now, in exchange for deducting $24.43 from their respective Social Security checks, they have some guarantees on what they will pay for medications in the 54-page formulary. Before, they paid out of pocket for medications, with no control over escalating costs.

In Glass’s case, the savings on six of the seven medications looks substantial. Last year Glass paid $2,901.28 for those six medications. This year he will pay $1,394.00 for the same prescriptions.

“To me this is a critical program. It’s a godsend,” Glass says. “When you are trying to live off Social Security, as Jan and I are, any savings is important.”

But Shirlee Sweigart isn’t sold on Medicare Part D, and she’s not signing up.

Because of a lung disability, the Mesa woman is qualified for Medicare even though she’s only 62. Her Humana Gold Plus HMO plan already had a prescription drug plan in place, but when Sweigart heard about Part D she called the Humana office to compare.

It turns out, she already was in the best plan for her, particularly since there are treatments outside prescription drugs that Sweigart gets at little cost to her. On other plans, those treatments would not be affordable. Reassured that her health coverage was optimal, Sweigart’s interest in looking into other plans waned — particularly when she heard of the complexity of Part D.

“Frankly, I have little or no trust in anything that’s this complicated,” Sweigart said. “My guess is we’re being ‘gaslighted.’ ”

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