The best Medicare Plan D strategy

Finding the right Medicare Plan D for those of us over 65 requires a bit of effort. I agree with columnist Peter A. Brown’s op-ed, “Medicare complexity worth the money” (BDN, Nov. 30). We are lucky to have our federal government trying to help us with our drug costs.

After spending about eight hours evaluating 12 companies, each offering one to three plans, I would like to share some of my thoughts on how to find the right plan.

First, one really needs to talk with a customer service agent, or even better, a “licensed specialist,” by telephone. Most of them are very pleasant, although there seems to be a wide range of competence.

The “Medicare and You 2006” brochure, sent to all Medicare participants by mail, lists the names of companies offering Medicare Plan D, or prescription drug coverage by state of residence. The listed Medicare telephone number, 1-800-633-4227, unfortunately only provides general information and no human to talk with.

The Maine Council on Aging (1-800-439-1789) provides a friendly human being, but one really has to talk with each company’s agent to get the details to calculate the numbers.

For me, on four medications, finding the right plan will save almost $1,000

a year, comparing the best with the worst plans.

To find the right plan, one needs to calculate the entire out-of-pocket expenses. They may include, depending on the plan, the Medicare yearly deductible of up to $250, monthly premiums, and co-payment for each medication. This information is available from all the companies I spoke with.

However, the other information one needs, and which is not easily available, is the total cost of each medicine, available from a pharmacy or pharmaceutical service. Some companies will reward you for using 90-day mail order by charging only two monthly co-payments for a three-month supply.

The total drug costs are important because they will determine when you reach the “gap” or “doughnut hole,” which varies, too, by plan from $1,850 to $2,250. At this point, one has to pay 100 percent of drug costs, except for generic drugs in some of the premium plans. If one’s total costs are high, one will reach that number sooner.

Because of differences in drug prices, from the various pharmaceutical companies I realized a savings of about $700 over 12 months. If you get the answer, “Contact your local pharmacy,” go to another company.

Add your out-of-pocket costs and determine when you will reach the “gap” by adding your total drug costs. Then consider how easy or difficult it was to get this information. This should give you the real winner.

I found one company/plan that was clearly better than all of the others.

William Babson Jr., M.D., is a retired physician who lives in Sinclair.