Keep prescription costs in mind when making Medicare decisions

Dear Toni: I am retiring Jan. 1 and have started to search for the right Medicare option for me and my wife, who is having breast cancer treatment at a local facility. Her cancer drugs are expensive, and I am concerned about the Medicare Part D out-of-pocket. I am diabetic and using the FlexPen, and I have prescriptions for high blood pressure. Most are generic, except for the diabetic prescriptions. Our Medicare Part B will begin Jan. 1 as my company benefits will end Dec. 31. What should I do to prepare for this medical insurance change? I will be 70, and my wife will have turned 65 by the time I retire. — Roger, Las Vegas

Dear Roger: While Medicare Part B is like gold because of what it offers, a cornerstone of Medicare planning is discussing Medicare Part D prescription drug plans. It is imperative to search for the most cost-effective Medicare Part D plan to cover your prescriptions. If a prescription is not covered, whether generic or brand name, then you will have to pay for it out of your own pocket.

Many Americans are so concerned about their doctors that they completely miss whether their prescriptions are covered under their new Medicare Part D or Medicare Advantage prescription drug plan.

Every Medicare Part D plan, whether it is a stand-alone Part D plan or Medicare Advantage plan (also known as Medicare Part C) with prescription drug coverage, has a formulary. If any of your drugs are not on that formulary, you will pay 100 percent for those drugs.

Another cornerstone is understanding the value of the Medigap/Medicare supplement open enrollment period. The Medicare and You Handbook, which the government mailed in September, has a “When to Buy” section on Medicare supplements. It says, “The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This 6-month period begins the first month you have Medicare Part B (Medical Insurance), and you’re 65 or older.” (You can also access the handbook online at medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf.)

During this six-month window, you can enroll in any Medicare supplement/Medigap plan without having to answer any health questions and not be denied coverage. After the six-month window, medical underwriting takes place, and you may not qualify for a Medicare supplement/Medigap plan.

Many new Medicare beneficiaries explore the option of a Medicare Advantage (Part C) plan. Unlike Medigap/Medicare supplement plans, it has a plan network to follow. But it can be a good option. With the health conditions that you and your wife have, you should speak with your doctors about what plans they accept and whether those providers accept the Medicare Advantage plans that you may be exploring.

Toni King is an author and columnist on Medicare and health insurance issues. For a Medicare checkup, email info@tonisays.com or call 832-519-8664.