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Health Insurance & Affordable Care Act

Navigating the Medicare Rx Discount Maze

Experts say go slow and ask questions before choosing your card.

Changing Prices

Experts remind seniors that prescription discount card sponsors are still allowed to alter prices as well as their percentage discounts as often as weekly. That means that a 20% discount one month could wind up substantially higher -- or lower -- on the next prescription refill. But Medicare will be monitoring price changes and will identify programs that deviate from the expected changes in pricing.

Many drug companies and pharmacies already offer discount cards of their own, though the Medicare-approved prescription discount card can't be used at the same time. Seniors with multiple cards should ask lots of questions to find out which one works best from month to month.

"Every time you go to the pharmacy, you want to figure out which of your cards will work the best. And it will change," Ginzler says.

Not Just Savings

Few cards will cover all drugs for most patients, and in the end, bottom-line discounts for most will land somewhere in the 10% to 15% range, estimates Trudy Lieberman, the director of the Center for Consumer Health Choices at the Consumers Union in Yonkers, N.Y.

Price alone "is not how you need to pick a card," she says.

Medicare beneficiaries will also need to find out how these prescription discount cards work with other drug benefits they may already have. Up to 2/3 of seniors have some form of private insurance through a former employer or the government that covers some drug cost. It is not yet clear how those pharmacies will treat existing cost-sharing arrangements, Lieberman says.

"This is an important issue for these people," she says.

Lieberman also cautions people to find out if their favorite pharmacy plans to honor the card they want. Different pharmacy chains take different cards, so take it into account if getting the biggest discount means switching stores, she says.

Low-Income Benefit

Despite their cautions, advocates are most excited about the card program's benefits for up to 7 million low-income seniors. Those with annual incomes below $12,560 per year for individuals and $16,862 for couples are automatically entitled to a $600-per-year credit to help pay for their prescription drugs on top of any discounts.

The credit will come embedded in the card they choose and will be deducted like a debit card as they buy prescription drugs, according to Medicare. The Social Security Administration is ready to send out mailers to all seniors who qualify for the money. Lieberman recommends that seniors and their families contact their State Health Insurance Program (SHIP) to find out if they qualify.

"That's a good benefit for people if they understand what they have to do to get it," she says.

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