December 29, 2005

Q:  My mother is confused about her choices for the Medicare drug benefit and asked me to help her out. Can you describe the different types of Medicare drug plans that are available to my mom? -- Connie

Dear Connie:

Your mom is not the only senior struggling to understand her Medicare choices. A recent survey found that just one in three seniors say that they understand the drug benefit. There are two general types of Medicare drug plans that are being offered in 2006, and you may want to consider which type of plan your mom prefers as a first step in helping her make this decision.

The first type of plan, called a Medicare prescription drug plan, covers prescription drugs and no other benefits. These plans, offered by Medicare-approved private companies, are generally best for people who need drug coverage but prefer to get their other benefits from the traditional fee-for-service Medicare program. There are at least 40 prescription drug plans offered in most states, so there are several choices for your mom to consider.

The second type of plan, called a Medicare Advantage plan, covers all Medicare benefits, as well as the new Medicare drug benefit. These plans are also sponsored by private insurance companies, and include HMOs, PPOs and private fee-for-service plans. Medicare Advantage plans sometimes offer additional benefits but typically impose restrictions on which doctors enrollees may see. In many areas, there are dozens of Medicare Advantage plans available – in addition to the stand-alone drug plans.

After you and your mom choose which type of plan she prefers, you may want to compare their prescription drug benefits. For people who take many prescriptions, choosing the best plan could have a big impact on annual drug bills. Plans vary in terms of premiums, the specific drugs covered, the amount charged for filling prescriptions, and the restrictions imposed, particularly for high-cost drugs.  

For additional information to help your mom, go to the Prescription Drug Plan Finder and the Formulary Finder at www.Medicare.gov, call 1-800-MEDICARE, or call your state’s health insurance counseling and assistance program.

This column was prepared by the Kaiser Family Foundation, an independent, non-profit private foundation based in Menlo Park, Calif., that is not affiliated with the Kaiser Permanente health plan. Do you have questions about the new Medicare drug benefit? Send your questions to Medicare Q and A. The Kaiser Family Foundation. 1330 G St., NW. Washington, DC  20005 or MedicareQ@kff.org. 

(c) 2005, Knight Ridder/Tribune News Service.

Distributed by Knight Ridder/Tribune Information Services.