Medicare Part D choices

The new Medicare reform law has ushered in some of the most significant changes to the Medicare program since its inception. The basic goal of these changes was to provide expanded health coverage choices for those eligible for Medicare, and to try and address the prescription drug needs of many Medicare-eligible Americans.

One of those changes – the Medicare Part D benefits – directly targets those prescription drug needs.

The Medicare Part D plans provide insurance coverage for prescription drugs. Medicare beneficiaries may purchase a Part D plan available in the area through private insurance companies, and those who buy a plan will pay monthly premiums and a co-payment or coinsurance for each prescription filled. These costs will vary based on the Part D plan choice.

Enrollment is voluntary

Beginning on Jan. 1, 2006, Medicare Part D plans take effect for people who have enrolled. Enrollment is entirely voluntary. Standard features of the plans include the following (or similar) highlights:

. A monthly premium (estimated

to be about $35);

. $20 annual deductible;

. The beneficiary pays 25 percent coinsurance for all expenditures between $251 and $2,250;

. The beneficiary pays 100 percent for all expenditures between $2,250 and $5,100;

. The beneficiary pays the greater of 5 percent coinsurance for $2 for generic drugs and $5 for brand name drugs for expenditures above $3,600 annual out-of-pocket threshold (the thresholds will be increased annually, based on average expenditures)

Consumers considering these plans should evaluate their prescription drug needs and the costs and benefits available under Medicare Part D and determine what makes most sense for their personal situations. Those who have Medicare supplement coverage can keep their current coverage without interruption regardless of their decision to enroll in Medicare Part D.

However, those who choose to enroll in the Medicare Part D prescription drug plan and currently have a Medicare supplement plan providing a prescription drug benefit (Plans H, I or J in most states) will have their Medicare supplement coverage modified to remove the prescription coverage from their current plan.

Make wise choices

. If you are considering purchasing a Part D prescription drug plan or one of the other available plans, it pays to shop around. Following are some shopping tips:

. Understand Medicare. Learn what your Medicare insurance does and does not cover;

. Find the best fit. Determine the supplemental plan that best fits your needs on your health and financial situation. Study all supplement plans before deciding on which one is the best for you;

. Find the best company. Price should be considered, but it may not be the most important factor – look for familiarity or a comfort level, solid ratings and strong financial stability. Also, consider the level of service offered before and after the sale. Your relationship with your insurance company will be long-term, so make sure it

will be a good one;

. Find the right agent. Don’t underestimate the value that an insurance representative can offer. Choose an agent willing to answer your questions and help you understand Medicare and Medicare supplemental insurance.

Above all, take the time to make sure you are making the right choices. Armed with a little knowledge, you’ll be well on your way to finding the right coverage, and the company that is right for you.

Tony Smart is a sales representative in Bangor for Mutual of Omaha Insurance Co.