- FRIDAY, Nov. 14 (HealthDay News) — With the enrollment period
for Medicare's Part D prescription drug coverage program for 2009 kicking
off Nov. 15, experts are advising seniors to choose a plan carefully
because premiums and covered medications can vary from plan to plan.

“As we enter the fourth year of the Medicare Part D prescription drug
program, we continue to see high satisfaction rates among beneficiaries
and high participation among plans,” Kerry Weems, acting administrator of
the U.S. Centers for Medicare and Medicaid Services, said in a
statement.

“However, plans do change their offerings from year to year. Some
beneficiaries may see significant premium increases or changes, such as
reduced coverage in the gap, if they stay in the same prescription drug
plan in 2009. We encourage individual beneficiaries to review how their
plans are changing and what other options are available to them to
determine which plan best meets their needs,” Weems said.

Paul Precht, director for policy and communications at the Medicare
Rights Center, echoed that advice. “Probably the higher premiums will get
some folks to look at their coverage options,” he said.

“It's going to be tough for people. The premium increases are
substantial,” Precht added. “People are also seeing increases in the
co-payments — it comes at a tough time.”

Medicare prescription drug coverage, sometimes called Part D, is
insurance for seniors and some disabled people that covers both brand-name
and generic prescription drugs at participating pharmacies. Open
enrollment for Part D runs until Dec. 31.

People who are satisfied with their current plan don't have to do
anything to stay enrolled. But those in so-called standalone plans that
only cover medications will see premiums increase by an average of $7.40 a
month, from $29.89 in 2008 to $37.29 in 2009, according to Medicare
officials.

Consumers should be smart when choosing a plan because premiums can
vary widely, from $10.30 a month to as much as $136.80 a month. Most
people should be able to find a plan in the lower premium range, according
to the Kaiser Family Foundation.

Most Part D participants who don't qualify for a low-income subsidy and
who don't switch plans will see an increase in their monthly premium,
according to the foundation. Twenty-seven percent will see premium
increases of at least $120 per year.

Premiums aren't the only consideration when choosing a plan. Another
important issue is making sure the plan you choose covers the drugs you
take. Covered drugs and restrictions on drugs vary from plan to plan, so
it's important to review each plan before making a choice, Precht
said.

One of the most serious issues in choosing a plan is the coverage gap,
or so-called “doughnut hole.” While in this gap in coverage, most Part D
participants must pay 100 percent of their total drug costs. For most
plans this will total $3,454 in 2009, according to the Kaiser Family
Foundation.

In 2009, nearly all Part D plans have a coverage gap, but one in four
plans offers limited coverage in the gap — generally coverage for some or
all generic drugs, though some plans also cover some or a few brand-name
drugs, according to the foundation.

Considering the price of drugs in a plan is also important, Precht
said. “There are a number of plans that charge quite a bit more for
generics than other plans,” he said. “Particularly for people who take
multiple drugs, that can make a difference between getting in the doughnut
hole or not getting in the doughnut hole.”

Precht said some people use a combination of strategies to reduce their
drug costs. “They rely on the cheap generics, if you can get it from some
of the 'big box' stores, using Part D for brand name drugs, plus buying
drugs from Canada as an option for brand-name medications,” he said.

People in Part D who meet the requirements for the low-income subsidy
usually aren't responsible for costs in the coverage gap. The gap was
intentionally included in the plan when it was launched four years ago so
costs would not exceed the limits set by Congress.

Another option for some people may be a so-called Medicare Advantage
Plan. These plans cover both your medical care and prescription drugs. But
before enrolling in one of these plans you may want to be sure your doctor
and hospital are part of the plan you choose.

More information

For more on Medicare Part D, visit the
U.S. Centers for Medicare and Medicaid.