Generic drugs online

Jerry Yunker had sticker shock this month when he saw how much his Medicare prescription drug plan would cost in 2009.

The $20.70 monthly premium he had been paying for his Humana plan will jump to $38.30. "That's about 80 percent," he said.

If he stays with the same plan in 2009, he said, his monthly premium and brand-name drugs he takes will cost him $750 more in 2009.

"I can make these payments," the Branson West resident said. "But the fact is a lot of people are not going to be able to," given the economic climate and losses that many seniors have taken on investments this year.

"For any of (the plans) to go up this year is ridiculous, but I think a lot of people are going to be hurt by them."

So as the enrollment period kicked off Nov. 15 for Medicare "Part D," the prescription drug benefit, Yunker was comparing the costs of some of the 48 standalone drug plans offered in 2009 in Missouri.

Medicare officials say they wish more seniors would be like Yunker during the Part D annual open-enrollment period ongoing through Dec. 31.

All people eligible for Medicare can enroll in a drug benefit plan, renew or change their existing plan. New benefits begin Jan. 1.

"Now it's more important than ever to compare plans," said Natalie Myers, Medicare's Kansas City-based health insurance and Part D policy specialist.

"This year's theme is 'Plans change, you change, shop and compare,'" Myers said. "Consumers will see plans changing. Coverage in the 'gap' may not be offered," she said. And some plans, especially the popular ones, will cost more in 2009.

So even seniors who like their existing drug coverage should compare it with other plans to see if they can get a better plan for their specific needs.

"My aunt is on Medicare and every year she's changed to a different plan," Myers said in a recent telebriefing with reporters. "There's always been one that's more economic (for her) for the coming year, and she will do the same this year."

About 6 percent of Part D enrollees switched plans between 2007 and 2008 plans every year, which she said is consistent with private sector plans.

Price change

Yunker said he feels betrayed by Humana's price jump after enrolling so many seniors at a low cost.

"They used it as a means of getting everyone in and counting on people never changing plans after that," Yunker said.

"I bought drugs from Canada before this," he added. "I'm not so sure I'm not going to go back and check the cost of doing that."

Myers said many plans were priced lower when Part D began in 2006 because companies didn't know what to expect.

"Now entering into the fourth year of the program, they have a good history of claims data, plus they have a good idea of what it will cost that age group and now they're pricing benefits accordingly," she said.

Health plan companies must get Medicare approval every year for their charges, she said. Despite the increases, they're in line with those in the private sector, she said.

Myers emphasized that low-income seniors who can't afford the costs may be eligible for the "Extra Help" program through their Social Security office.

No one plan is right for everyone, Medicare officials say.

Seniors should choose a plan based on several factors: coverage for the brand-name and generic drugs they take or expect to take in 2009, cost of monthly premium and whether the plan provides help during the coverage "gap."

Medicare penalty

Don't wait until you need prescriptions to enroll in Part D, Myers said.

If you don't have existing drug coverage through a recognized program (labor union, retiree plan, Veterans Administration, etc.) Medicare will add a financial penalty to the cost of every month's premium for life. She said Medicare didn't enforce the penalty until 2008.

Part D benefit plans, like other insurance plans, are supported by premiums that members pay, whether or not they use it, Meyers said.

Medicare officials have explained: People can't expect to buy home insurance to cover fire damage after the house has burned down; seniors can't expect to buy coverage once they need prescriptions.

The penalty is 1 percent of the national basic premium for every month a senior could have had coverage through Part D but did not enroll and did not have coverage with another source.

In 2009, the national base premium is $30.36. If a senior doesn't sign up for 10 months, a late enrollment fee of $3.04 would be added to each month's premium thereafter. The government will waive penalties only if the senior is a very low income person who qualifies for Medicare "Extra Help."

Some Part D changes for Missourians:

- There are 48 Medicare "standalone" drug plans, down from 52 in 2008. Some plans ended, some began. Drug coverage is also available through 73 Medicare Advantage, or Medicare Health Plans (combined health/drug plans) -- only 21 in Greene County.

- There is one Part D plan with a monthly premium under $20 and two under $25 per month. The lowest monthly premium offered in Missouri is $14.50 compared to $17.20 in 2008.

"That's still very affordable, if you need a benefit but you do not take any drugs at all, to have coverage for peace of mind," Myers said. The highest monthly premium is $106.80.

- Twelve plans offer some coverage in the "gap," 36 plans offer no gap coverage.

- The "gap" is the span of a senior's drug charges not covered by Part D. In 2009, the gap in coverage begins after drug costs paid by both the senior and drug plan reaches $2,700. The senior then must pay all drug costs until his out-of-pocket (including his share of the $2,700) totals $4,350. Then, catastrophic coverage begins. Low-income seniors who get Medicare Extra Help don't have a gap in coverage.

- No standard Part D plans cover brand name drugs during the gap, but 12 plans in the state will offer more expensive plans with some coverage in the gap. $54.50 is the lowest monthly premium with any generic coverage in the gap. In 2008 the lowest premium offering comparable coverage was $40.70.

- The Medicare drug plan comparison online tool at www.medicare.gov now allows seniors to compare three plans at once while getting a breakdown of monthly drug costs and whether the plan requires drug prior authorization, quantity limits or "step therapy" -- cheaper drugs first.

"There are affordable plans out there," Myers said.

"If they haven't signed up because they have no drug needs at this time, there are programs for less than $20 a month. It's best to enroll in a plan, though it may be the least expensive one in the region, so they have coverage."