Part D - 2011 renewal

Medicare Matters

Phil Castell

Yes, it is that wonderful time of year once again when people on Medicare get inundated with paperwork. All Medicare Part D companies are required to send out an Annual Notice of Change. This notice usually is comprised of several booklets, each 40 or more pages in length.

Most people will glance at the booklets and think, "Well, my plan worked pretty good this year, I will stick with it another year."

You may be OK if you do that, but on the other hand you may miss some very important information. Please take a few minutes to, at the very least, check out the following two bits of information buried in the fine print.

1) What will my premiums and deductibles be for 2011?

2) Will all my medications be covered ?

Just because a medication was covered this year does not necessarily mean it will be next year. If all you take are inexpensive generics, chances are they still will be covered. But if you take some pricey Tier 2 or Tier 3 brand-name drugs, please check the formularies you have received.

More plans reviewed

In last month's column, I gave you the highlights of the 2011 Part D offerings from AARP and Humana. It is now a month later and I have had plenty of chances to review the other plans available.

Most surprising are the plans offered by Aetna, including the popular co-branded product with Costco. This plan was priced at $36.50 for 2010 and it will be $61.40 in 2011, an increase of more than 65 percent. Yikes. To make matters even more confusing, Aetna has been placed on restriction by CMS, the parent organization of Medicare. They are listed as having plans available for 2011, but as of Nov. 1 their plan details, including formularies and co-pays, are not on the wonderful www.Medicare.gov website. This makes a comparison virtually impossible.

In 2010, First Health Part D offered the lowest-priced plan in the state at $8.80. If people do not read their packages, they may be surprised to see that figure will change to $30.30 for 2011. The plans and benefits also have changed, along with the premiums.

If you take no medications at all, the lowest-priced plan is once again with Humana. This is the plan that is co-branded with Walmart and is available nationwide at the same low premium of $14.80.

A company whose name I may not have mentioned previously is popping up quite frequently as I run though people's medication lists and that is Wellcare. They have a plan called the Wellcare Signature with a higher than average monthly premium of $61.30. It has a $0 deductible (and so it should at that price) but then the co-pays on many generics are $0. That is right I said $0. I see many people who take six, eight or even 10 different prescriptions that are all generic. They could pay the $61 premium each month and then walk out of the pharmacy without shelling out a single penny for all their medications.

Talking about $0 co-pays, have I told you how you can get Lipitor with a $0 co-pay. What, I can hear you gasping, $0? For Lipitor? The Community CCrx Choice offered by Universal American has a monthly premium of $79, has no deductible and a $0 co-pay for Lipitor. Most people who are on Lipitor realize it is not a generic and is quite expensive, so this will be welcome news for some.

Talking of Lipitor, a few plans do not cover it at all so this is yet another reason to review the formulary you received in the mail.

More Medicare Advantage news

I will finish up with a couple of quick comments about Medicare Advantage Plans in Clallam County for 2011.

With the demise of the Sterling Medicare Advantage plans, Sterling agents are pointing out that they are not leaving the county - they just have different plans. That is 100-percent correct that they are offering a traditional Medicare Supplement as an alternative. I did not intend to mislead or confuse people when I said Sterling MA plans would not be available in Clallam County in 2011. Also the Sterling Medicare Advantage plans still are available in Jefferson County.

A company called Community Health Plan of Washington is new to this county and it has three Medicare Advantage plans available in Clallam County, even one with prescription coverage included for a $0 premium. It is an HMO-based plan where you have to see a primary care physician before they will refer you to a specialist.

"Wow, a $0 premium plan including Rx, what a screaming deal, sign me up," is a variation of comments I have heard when I tell people about it. Unfortunately there is a downside. They currently only have three providers in Clallam County and all three work in Clallam Bay and Forks. Not a single provider in Sequim or Port Angeles. Folks, I am sorry if I got your hopes up.

The bottom line is, read any material you receive to make sure the plan will be suitable for you for next year. If you need any assistance, you may call Medicare at 800-633-4227 seven days a week, 24 hours a day. State Health Insurance Benefit Advisors (SHIBA) can be reached at 452-3221 or call a local insurance agent.

Phil Castell is an independent insurance agent in Sequim. He can be reached at 683-9284 or PhilCastell@msn.com.