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Medicare Health Insurance Users Confused About Drug Coverage

Seniors who use Medicare drug coverage plans are confused

Medicare has become a confusing mess for many seniors, with a a myriad of choices, confusing terms, premiums and formularies from which to choose. Medicare Part D, the portion that provides health insurance coverage for prescription drugs, requires seniors to analyze individual drug costs, co-pays and deductibles to get the best rate and the best plan. The list of medications that a company covers is called the formulary and these can change frequently.

With Medicare premiums increasing up to 25% in 2009, a beneficiary can save a lot of money by understanding what is covered and what is not. Medicare recipients must re-enroll every year and knowing what companies pay for is a challenge for many. Read more about questioning CMS on Premium increases for Medicare Prescription drug plans.

The Part D drug coverage was initiated by congress in 2006. Unfortunately they failed to call for a uniform drug benefit so dozens of private insurance drug plans are marketing different plans to seniors. There is no plan offered directly by the government and each year private companies start advertising heavily, encouraging seniors to switch to a better plan.

To make matters more confusing, Part D drug coverage has a gap in coverage called the “donut hole”. After $2,510 is spent on pharmaceuticals, a senior is responsible for all of the next $3,216 prescription drug cost herself. Once that is paid, the coverage kicks back in through the remainder of the year.

Medicare recipients are eligible for benefits and drug coverage at age 65, regardless of income, health status or current prescription expenses. There are two types of Medicare plans that provide prescription drug coverage: Medicare Prescription Drug Plans and Medicare Advantage Health Plans.

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Medicare offers a Plan Finder for beneficiaries that will walk a person through Part D coverage.

Another excellent site is AARP, Medicare Prescription Coverage, where there are tips for enrolling in a plan and keeping prescription costs down.

These sites are helpful for computer savvy seniors in finding more information about the Medicare health insurance coverage plans, but they leave out many who do not have the skills or tools to navigate these confusing choices and options online. For them, there is a help line at 800-MEDICARE (1-800-633-4227) that will help seniors understand their choices. The senior will need to have their medicare number on hand when they call and it is a tedious recorded voice-mail process, so some may need help even with making the phone call.

Many seniors require the help of their adult children to help them get through this process. It is important to know every drug that is currently being taken, including the name and dose, to be able to compare to the formulary of the plan. Read how boomers can help seniors finding best medicare prescription drug plan.

Open enrollment for the Medicare Part D lasts until Dec. 31. Medicare users can change plans or options until that time. Unless they sign up before Dec. 31, some recipients may have no drug benefit for 2009.

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