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Health Care Reform:

Health Insurance & Affordable Care Act

Consumer Magazine Offers Tips to Analyze Drug Benefit Options

Picking the Best Medicare Drug Plan

Sorting Plans Into Categories

Consumer Reports pulls no punches in describing the "market free-for-all that makes it difficult for consumers to make apples-to-apples comparisons of the 40 or 50, or even 60 plans that they may be offered in their area."

The article also provides these definitions of the three categories of plans:

  • Standard plans: Follows the government's blueprint exactly, with a $250 deductible and 25% co-insurance. May not cover all out-of-pocket costs and can be hard to find.

  • Equivalent or alternative plans: No deductible or deductible of less than $250. Users make co-payments of specified dollar amounts instead of paying a percentage. May work well for seniors who take few drugs or lots of inexpensive generic drugs.

  • Enhanced plans: Low or no deductible, lower co-payments, and more coverage of out-of-pocket drug costs. May appeal to people whose total prescription expenses, including the government's portion, fall between $2,250 and $5,100.

Those terms aren't official. Sellers can name their plans anything they like, so it's crucial to get the details on your options.

More Medicare Tips

Ready to get started? Consumer Reports recommends using Medicare's web site,

If you call Medicare's phone number ((800) 633-4227), be ready to hear recorded announcements before reaching a person, the article advises.

More tips:

  • Check plans' drug formularies. Formularies are lists of covered drugs.
  • Know that drug formularies can change anytime.
  • Ask about restrictions on certain drugs. For instance, some plans must "preauthorize" use of certain drugs.
  • Ask whether "step therapy" is used.

In step therapy, patients start by taking the least expensive drug that's appropriate for their condition. If that drug doesn't work, they try the second cheapest drug next, and so on until patients and their doctors find a drug that works.

Time Ticking Away

May 15 is the deadline for current Medicare participants to sign up for a Medicare drug plan.

Miss that deadline, and you'll pay for it. Your next window of opportunity is in November; your coverage won't start until January 2007, and you'll pay a late-enrollment fee.

Latest Health Reform News

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