Making Sense of Medicare Advantage and Part D Open Enrollment By Stephen L. Cohen, MD Austell, GA
About this presentation: We know that a lot of material is presented here. Please go to www.medicaredrugsavings.org and click on You can print a copy of the important screens seen on www.medicare.gov where you will find the LEAST EXPENSIVE Medicare plan.
Are You (or Your Parents/Grandparents) on Medicare? Learn how 10-15 minutes online might help you save over $1,000/year on medicines. The best plan for you will depend on what medicines YOU are taking. One plan may be better for YOU while a second plan may be better for another family member.
Medicare D example of saving $2886 for someone taking 7 medicines (1 for asthma, 2 for diabetes,2 for cholesterol and 2 for high blood pressure- 3 brand and 4 generic medicines) Least expensive plan estimated cost $2426/year Most expensive plan estimated cost $5312/year (medicine cost without a Medicare D plan $7376/year)
Types of Medicare Plans Medicare A: Inpatient care in hospitals and nursing homes. Medicare B: Outpatient care doctors bills, lab tests, Xrays, physical therapy. Medigap plans: Pay for the deductibles and copays for bills from providers such as hospitals, doctors and laboratories. They DO NOT pay for medicines.
Types of Medicare Plans Medicare C: Medicare Advantage Plans are offered by private insurance companies. Premiums and covered benefits vary between plans. They may provide additional benefits not covered by traditional Medicare A and B plans. They may limit which doctors, hospitals and pharmacies you can use.
Types of Medicare Plans Medicare D: Covers prescription medicines Offered by private insurance companies Cost and covered medicines varies between plans
Beward of Medicare D Marketing Pharmacies such as Wal-Mart, Walgreens or CVS or organizations such as AARP may suggest that you sign up for a specific Medicare D Plan. These companies and organizations may provide you with excellent service but the Medicare D plan which they sponsor may NOT be the one that provides YOU with the best value.
Costs for Medicare D Plans Monthly premium: What you pay the insurance company every month. Copay: What you pay each time you buy a prescription. Deductible: How much you have to pay before the insurance company starts paying for the medicines.
Making Sense of the Choices There are HUNDREDS of insurance companies which cover different medicines, charge different premiums and different co-pays. How can you ever figure out which plan offers the best value????
Should you get a Medicare D plan? BE CAREFUL if you have other coverage for your medicines, such as an insurance policy from a previous job, the military (Tricare) or an Indian Health program. Do you want a Medicare Advantage plan instead?
Go to www.medicare.gov and click on
Enter your zip code then click on
If your zip code includes more than one county you may be asked in which county you live. If so choose your county then click
Choose the 2 appropriate boxes ( How do you get your coverage? & Do you get help? ) regarding your Medicare then click
In this screen you can enter your medicines. You have to enter them correctly to get a correct estimate of the cost of the different Medicare D and Medicare Advantage Plans
Type in the name of your first medicine then click
You may be asked to select one medicine from a list. If so pick the best match by clicking In this example you can pick a generic or brand name drug.
Should I pick a generic or brand name drug? Generic medicines have the same chemical structure as the brand name medicine and are usually cheaper and just as effective as the brand name medicine. Many Medicare D and Advantage plans will not pay for a branded medicine if a generic version is available. For this reason we suggest that you always choose a generic medicine when filling out this form, although you can choose the branded medicine.
Choose the dosage (pill strength). Choose the quantity (number of pills) in the prescription. Choose the frequency (how often the prescription is filled). Choose the type of pharmacy where you want to fill your medicine. Click
Enter your next medicine, then click
Click on
Select Dosages, Quantity, Frequency and Pharmacy Type then click
After you enter all your medicines, click
Click to choose pharmacies in your area to buy your medicine
See the two pharmacies listed, then click
Choose from 3 different types of plans: Select 1 st option then click A Medicare D plan (drugs only)-chosen for next slide A Medicare Advantage plan which also includes doctors and hospitals A Medicare Plan without any drug coverage
In this example, we found 25 Medicare D plans for someone taking 7 medicines (1 for asthma, 2 for diabetes,2 for cholesterol and 2 for high blood pressure- 3 brand and 4 generic medicines) Least expensive plan estimated cost $2426/year Most expensive plan estimated cost $5312/year
Wow, that s a big price difference! Yes, it is. Remember that the web site provides an estimate, not an exact amount of your annual costs for medicines. The total cost will vary depending on: Where you live, What medicines you take, Whether you buy your medicines at a local pharmacy or get them through the mail, and Whether you get generic vs. brand name medicines.
So how do I sign up? Click on the name of the insurance company(results on next screen) OR Click on and enroll online OR Use an insurance agent
Clicking on the insurance company on the previous screen provides more information about the company including a phone number to call for further information.
Choosing a Medicare Advantage Plan: Choose 2 nd option then A Medicare D plan (drugs only) A Medicare Advantage plan which also includes doctors and hospitals A Medicare Plan without any drug coverage
Medicare Advantage Plan vs. Traditional Medicare
16 Medicare Advantage plans -- Least Expensive
16 Medicare Advantage plans -- Most Expensive
Select plans you want to compare then click
Results of Medicare Advantage Plan Comparison
Can I get help to pay for my Medicare D or Medicare Advantage plan? There are a number of resources to help people with limited income pay for these plans, medicines and other expenses such as food and electricity. Go to www.medicaredrugsavings.org and click on or go to www.medicaredrugsavings.org/gethelp
Help Us Help You We would like to do a better job helping you save money on your Medicare Drug prescription costs. Please go to and click on now to complete a short survey on this presentation. If you plan to use www.medicare.gov to explore the available Medicare D drug and Medicare Advantage plans you can take the survey afterwards.
MedicareDrugSavings.Org Learn how YOU can save hundreds to thousands of dollars on your Medicare D or Medicare Advantage plan See a video presentation on how to navigate www.medicare.gov to save this money Get printouts of the important screens to use for reference when looking at www.medicare.gov After you see the video please take the survey to help up improve our web site
Can you change your Medicare D or Advantage plan for the coming year? Most people can only change plans during the open enrollment period. This period is October 15-December 7 each year. Except
You can sign up for a plan outside of open enrollment if one of the following exceptions applies: It s your 65 th birthday and you haven t previously signed up You move away from the area covered by your present plan You lose your Medicaid coverage You are released from jail There are other exceptions which you can see by going to www.medicaredrugsavings.org and click on