Medicare Part D, who needs it?

Dear Savvy Senior,

I need to help my mother figure out the Medicare prescription drug coverage before the deadline, but I don?t understand it myself. How can we know if she really needs a plan and if so, how do we choose the right one?

Procrastinating Pam

Dear Pam,

For Medicare beneficiaries, the May 15 enrollment deadline for choosing a Part D prescription drug plan is rapidly approaching (unless congress extends it at the last minute) ? but who really needs it? Here are some tips that may help you decide.

Who Needs It

While all Medicare beneficiaries are eligible for drug coverage, who actually needs a Part D plan? The answer depends on how you pay for medicine now. You need a Medicare drug plan if you have:

? Little or no coverage: If you spend more than $750 a year on medications you need a drug plan. But, if you?re healthy and spend less than $750 you may still want to enroll in a (low premium, zero deductible) plan to provide drug coverage if your health deteriorates and to avoid the late enrollment penalty, which is a 1 percent premium increase each month you delay.

? Limited income: If your monthly income is less than $1,225 ($1,650 for couples) you need to enroll in a Part D plan, and you also need to contact Social Security (800-772-1213) to see if you qualify for the Medicare ?extra help? assistance.

? Medigap insurance: If you have a Medigap (supplemental insurance) policy that covers drugs, drop the drug coverage portion and get a Part D plan because the coverage is better.

Who Doesn?t Need It

If you fall into any of these categories, you either don?t need Part D, or don?t need to worry about enrolling in one.

? Employer coverage: If you already have drug coverage through a former employer or union, that?s as good as or better than Medicare?s ? you don?t need Part D. You should have received a letter indicating if the coverage is creditable or not. If you can?t remember receiving a letter, contact the company?s human resources department. (Note: If the company decides later to reduce or drop their coverage you can enroll in a Part D plan at that time without penalty).

? Government benefits: If you have drug coverage from Veterans Affairs, the Federal Employees Health System or TriCare, your drug coverage is probably better than Medicare?s drug plan so you don?t need Part D.

? Medicare Advantage: If you have Medicare through a managed care plan like an HMO or PPO ? stay there. Your medicine is already covered.

? Medicaid: If you?re on Medicare and Medicaid or Supplemental Security Income (SSI) you?re already been enrolled in a Part D plan.

Choosing a Plan

If you think your mom would benefit by having a Medicare drug plan, here are some steps that can help you select a plan to meet her needs.

? Gather information: Start by making a list of the drugs your mom takes along with the dosages and costs. Your mother?s pharmacy should be able to print you a copy of this information. You?ll also need your mom?s Medicare number, birth date, zip code, preferred pharmacies and current (if any) drug coverage.

? Start shopping: Once you get organized go to www.medicare.gov and click on Compare Medicare Prescription Drug Plans. From there you plug in your mom?s information and get a personalized search that will breakdown and compare the plan?s costs, coverage, list of preferred pharmacies and more. If you?re not Web savvy, you can call 1-800-MEDICARE and they?ll do the comparing for you over the phone.

? Double check: Be sure the plan you choose covers all the drugs and dosages your mother currently takes. If it doesn?t, call her doctor to see if there?s an alternative medication that?s on the plans approved drug list or look for another plan.

? Enroll: You can enroll in a drug plan through Medicare, either online or by phone, or go directly to the plan you selected. (Note: If you don?t like the plan you?re in, you can change plans each year between Nov. 15 and Dec. 31).

Savvy Tip: If you need additional help choosing a plan contact your local SHIP (www.shiptalk.org, 800-677-1116), who provides free Medicare Part D counseling.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit www.savvysenior.org. Jim Miller is a regular contributor to the NBC Today Show and author of “The Savvy Senior” book.