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Most Ohioans to pay more each month for Part D coverage. Some choices cut
By Cheryl Powell
Beacon Journal medical writer
Published on Friday, Sep 26, 2008
Seniors and disabled Ohio residents who get their drug coverage through Medicare-approved plans can expect to pay higher monthly premiums next year, especially if they want comprehensive coverage.
The Centers for Medicare and Medicaid Services (CMS) on Thursday released details about the options available in 2009 through Medicare's prescription drug coverage program, also known as Medicare Part D.
Next year, the 1.8 million Ohio residents covered by Medicare will be able to choose among 49 drug plans, down from 58 this year.
Medical Mutual, MemberHealth (now part of Universal American) and Paramount no longer will offer Medicare drug plans to individuals next year, according to data released by CMS. Several other companies are reducing the number of options they offer.
Monthly premiums in 2009 will range from $16.90 for a plan from First Health to $97.50 for a plan from Humana.
This year, First Health has been offering the least expensive Medicare Part D drug plan at $16.60 a month.
Overall, more than three-fourths of Medicare Part D prescription drug plans in Ohio are increasing monthly premiums in 2009 for the same or similar coverage.
Along with Medicare Part D plans that cover medicine, prescription coverage is available through Medicare Advantage managed-care insurance plans that also offer medical coverage, such as help paying for doctor visits and hospital stays.
In Summit County alone, 71 plans will be offered next year by 15 companies, according to CMS.
The optional drug coverage and managed-care plans are available to everyone covered by Medicare, the federal health insurance program for people ages 65 and older and some younger disabled Americans.
The federal government contracts with private companies to provide drug coverage to Medicare recipients who sign up for the plans.
Next year, 21 of the 49 available Medicare drug plans in the state have deductibles before coverage starts, according to an analysis of information released by CMS. Those deductibles can be as high as $295, up from $275 this year.
Enrollees in 37 of the available plans also will face a gap in coverage that will potentially force them to pay for thousands of dollars worth of medicine next year without any help.
'Doughnut hole'
This so-called ''doughnut hole'' can start after total drug costs (the amount the enrollee and the plan paid) reach $2,700, an increase from $2,510 this year.
Enrollees then must spend more than $3,000 of their own money during the gap in coverage before catastrophic coverage starts. After that, participants pay much less out of pocket in co-payments.
Just as this year, no plans will be available in Ohio next year that pay for brand-name medicine without a potential gap in coverage.
A dozen Medicare drug plans will provide at least some generic medicines without a gap in coverage. This year, 17 plans are offering enrollees limitless coverage for at least some generic drugs.
But those plans will be the most expensive, with monthly premiums ranging from $50.10 for a plan from SilverScript Insurance Co. to $97.50 for a plan from Humana. (This year, the cheapest plan that covers at least some generic drugs without a gap in coverage costs $42.20 per month.)
For those selecting Medicare Advantage plans, 24 options will be available next year for no monthly premium.
Monthly premiums for Medicare managed-care plans next year will range from $0 to $175 for Akron-based SummaCare's most comprehensive coverage.
Medicare drug plans must notify enrollees about any major changes in coverage by the end of October.
Reviewing options
Medicare recipients should carefully review changes to their current plan and review all their options, CMS Acting Administrator Kerry Weems said.
''We want every beneficiary to know that during each enrollment year, plans do change their offerings,'' he said.
Detailed, personalized information about available Medicare Part D drug plans and Medicare Advantage options for 2009 will be available by mid-October by logging onto Medicare's Web site at http://www.medicare.gov or calling 800-633-4227.
Companies can start marketing their Medicare-approved plans on Wednesday.
Open enrollment starts Nov. 15 and runs through Dec. 31. Changes are effective Jan. 1.
Everyone but the poorest enrollees pays about a quarter of the monthly premium; the government picks up the rest.
People with limited income can qualify for drug coverage for free or with reduced monthly premiums and lower out-of-pocket costs.
For information about the extra help, contact the U.S. Social Security Administration at 800-772-1213 or online at http://www.socialsecurity.gov/prescriptionhelp.
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
Seniors and disabled Ohio residents who get their drug coverage through Medicare-approved plans can expect to pay higher monthly premiums next year, especially if they want comprehensive coverage.
Get the full article here.
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