Seniors will face dozens of Medicare prescription drug options before the enrollment period ends this month, and your clients will have health care costs on their mind as they shop for themselves or their parents.
It’s a good time to open up conversations about future medical expenses, especially when it comes to clients who are shy about confiding medical issues and those reluctant to purchase long term care policies.
Advisors can offer immediate help on the tricky Medicare Part D choices. Consumers Union has been monitoring the total cost of buying five common drugs in five states since the Part D drug program began in 2006. Last year, the nonprofit group found that shopping among plans could save individuals more than $2,200.
Most people focus on premiums, which may not reflect the true cost of a plan. It may help to begin with clients by making the analogy that the premium is like a car’s sticker price. As Adrienne Muralidharan, a senior Medicare specialist for Allsup Medicare Advisor, said: “The cheapest car could have awful gas mileage, excessive maintenance costs and service and a design that does not match your needs. The same goes for prescription drug plans.”
Muralidharan offers the following checklist:
1. Check deductibles and co-payments as well as the premium when evaluating costs.
2. What drugs does the Part D plan cover?
Clients need to see if the plan covers all medications. They must also determine if the plan covers the brand name or generic version of a drug. Some people experience adverse reactions to generics and require the brand name. If a plan covers some prescriptions, but not all, they must evaluate the cost of those not covered.
3. What pharmacies can your clients use?
Medicare prescription drug plans contract with pharmacies. Even within network plans may charge a higher co-pay for certain pharmacies.
4 Does your client need “donut hole” coverage?
In 2011, the gap in coverage comes after the individual’s and plan’s combined costs reach $2,840. At that point, the person is responsible for all costs until catastrophic coverage kicks in — when the individual’s and plan’s combined costs total $6,448. For 2011, beneficiaries will have a 50% discount on brand drugs and 7% discount on generic drugs bought while they are in the donut hole.
Not everyone who expects to fall into the donut hole should buy a more expensive Part D policy to cover the gap.
“Someone with very high-cost medications could move through the donut hole quickly to reach catastrophic coverage, where the plan will cover 95 percent of their costs,” Muralidharan says
5. Does your client have comprehensive information on the policies that interest her?
Part D selection services offered online and by store pharmacies may not provide all the relevant information. Steer clients to Medicare.gov or for one-on-one help, to Allsup’s service.