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Many insurers in Ohio hike premiums for 2008; none offers plan without gap in coverage for brand-name prescriptions
By Cheryl Powell Beacon Journal medical writer
Published on Friday, Sep 28, 2007
Many elderly and disabled residents in Ohio who get their medicine through Medicare prescription drug plans can expect to pay more next year if they want the same coverage.
The Centers for Medicare and Medicaid Services on Thursday released some details about the options available in the third year of 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 58 drug plans, with monthly premiums ranging from $16.60 for a plan from First Health to $98 for an option from EnvisionRx Plus.
This year, Humana has been offering the least expensive plan at $16 a month. Next year, however, the company's cheapest option will cost $27.10.
Many other companies also are increasing monthly premiums for the same coverage next year, and none will sell plans in Ohio that pay for brand-name medicine without a gap in coverage.
Next year, 24 of the 58 plans have deductibles before coverage starts. Those deductibles can be as high as $275, up from $265 this year.
Enrollees in some plans also face a gap in coverage that will force them to pay for more than $3,000 worth of medicine next year without any help.
This so-called ''doughnut hole'' can start after total drug costs (the amount the enrollee and the plan paid) reach $2,510.
After enrollees spend thousands more dollars, catastrophic coverage starts, and participants pay much less out of pocket in co-payments.
Plans that provide limitless coverage for at least some generics next year are passing along the largest premium increases, according to an analysis of data provided by CMS.
Some of '08 changes
Among some of the changes found in that analysis:
An AARP plan offered through UnitedHealthcare that offers limitless coverage of generics will increase from $48.60 a month to $62.90.
Anthem is increasing the monthly premium for a plan with limitless coverage of some generics from $39.60 to $71.
Aetna also is raising the monthly premium for its most comprehensive coverage from $69.70 to $77.60.
And Sterling Prescription Drug plan is boosting its premium for people who want unlimited coverage of generic drugs from $59 per month to $79.90.
Some companies including Health Net, SierraRx, UniCare and WellCare no longer will sell plans that have no gap in coverage.
Some plans cheaper
But at least 11 companies are offering a less expensive plan next year. Among those cutting their premiums: Cigna, Coventry AdvantraRx, First Health Part D, HealthSpring Prescription Drug Plan, Medco, Medical Mutual of Ohio, MemberHealth, Paramount Prescription Drug Plan, RxAmerica, SilverScript and UniCare.
Medicare Part D plans must notify enrollees about any major changes in coverage by the end of October.
Enrollees shouldn't assume their drug coverage will stay the same next year, warned Deane Beebe, spokeswoman for the Medicare Rights Center, a national consumer advocacy group. ''Everybody needs to go back and decide whether there is a better option out there for them,'' she said.
Along with Medicare Part D plans that cover medicine, prescription coverage is available through Medicare Advantage plans that also offer medical coverage, such as help paying for doctor visits and hospital stays. Information about Medicare Advantage options for 2008 is expected to be released by mid-October. At that time, Medicare recipients will be able to get detailed information about all the Medicare Part D and Medicare Advantage plans by logging onto Medicare's Web site http://www.medicare.gov or calling 800-633-4227.
Start enrolling Nov. 15
Companies can start marketing their Medicare-approved plans on Monday. But seniors should take their time to pick a plan, Beebe said.
Open enrollment starts Nov. 15 and runs through Dec. 31.
''Sign up for nothing until you go back, shop around, talk to other people and, most importantly, find out the fine print about these plans,'' Beebe said. ''You've got plenty of time to make a decision. Nothing will go into effect until Jan. 1, so do your research before you sign up for anything.''
The federal government contracts with private companies to provide drug coverage to Medicare recipients who sign up for Medicare Part D plans.
Everyone but the poorest enrollees pays about a quarter of the monthly premium; the government picks up the rest of the tab.
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
Many elderly and disabled residents in Ohio who get their medicine through Medicare prescription drug plans can expect to pay more next year if they want the same coverage.
Get the full article here.
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