Seniors Urged to Research Their Drug-Plan Options

A pharmacy manager fills a prescription Aug. 7, 2007.

hide captionA pharmacy manager fills a prescription Aug. 7, 2007.

Joe Raedle/Getty Images

Thursday is the start of the annual six-week open-enrollment period, when Medicare patients can join or switch drug plans for 2008.

Seniors who struggled to choose from about 50 plans two years ago when the program started have mostly stayed put. But even Medicare officials say sticking with the same plan may not be the best financial or health decision.

"You should take this time and get a checkup for your plan and make sure that you're in the right plan," says Kerry Weems, acting administrator of the Centers for Medicare and Medicaid Services.

Dozens of seniors took the opportunity to do just that Wednesday at the Holiday Park Senior Center in Wheaton, Md. It was one of several stops Weems and other Medicare officials made as part of a press tour in a giant Medicare bus.

Souad Shammas showed up to find out if there might be a better drug plan for her, "because I have exhausted all my money with AARP and now I am paying from my pocket 100 percent."

Shammas fell into the notorious "doughnut hole" — the gap in the Medicare drug benefit where patients must cover all their own costs unless they spend several thousand dollars, after which catastrophic coverage kicks in.

Leta Blank, head of the Montgomery County Senior Health Insurance Program, typed the names of the four drugs that Shammas takes regularly into Medicare's Web site and quickly found several plans that would save her several hundred dollars next year.

But Tricia Neuman of the Kaiser Family Foundation says that people like Shammas, who sought help in finding a better plan, are the exception.

"The reality is, at least this past year, most people did not switch plans. They didn't go through the process of looking for alternatives," Neuman said. "I don't really blame them. It's not easy to look for alternatives and it takes a lot of work. But they could find themselves paying more and getting less if they don't check out their options."

Seniors who have changed the drugs they regularly take should definitely check to see whether a different plan might save them money.

But those who have not changed drugs could also benefit. Some insurance plans change coverage considerably from year to year.

Many drug plans are raising their monthly premiums. Average premiums are expected to rise about 17 percent, or roughly $4.50 a month, according to the Kaiser Family Foundation. Some plans might actually lower premiums but boost how much they charge for individual drugs, which would raise total costs.

At the same time, many plans are starting to charge different amounts not just for different types of brand name drugs, but for different types of generic drugs, too.

"One of the interesting things we're seeing this year is that they're not covering all generics, we're seeing some plans that cover some generics, some plans covering preferred generics, and of course, there are a few that are covering all generics," Neuman says. "But again, it's really up to the consumer to read the fine print and figure out what they're getting, because they may assume they're getting better coverage than they actually are."

Some Medicare beneficiaries will be forced to switch plans for next year.

"Twenty-eight percent of low-income subsidy recipients are currently in plans that are free to them, but will not be free to them if they stay in that plan in 2008," says Kevin Prindiville of the National Senior Citizen's Law Center. "That means they're going to be facing some major changes that will cause some major disruptions in coverage."

Those are people with incomes under about $15,000 a year for individuals, and $20,000 for couples. They are eligible for big discounts from Medicare, but they get the full benefit only if they sign up for certain low-cost plans. And with many plans raising premiums, as Prindiville says, an estimated 2.5 million people will have to switch plans in order to keep getting all of that additional government subsidy. Those beneficiaries will still be able to stay in plans whose premiums are going up beyond the government's limit, but they'll have to pay a bigger share of the premium.

Correction Nov. 15, 2007

In this story, NPR reported that about a quarter of low-income people who receive Medicare's extra help for drug costs will need to switch drug plans to keep the government subsidy. Actually, they can stay in their current plans and keep the extra help, but they'll have to pay higher premiums to do so. The story below has been revised accordingly.

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