Plans in 2012
Medicare Advantage plans provide
an alternative way for people to
receive Medicare benefits, typically through private HMOs and
PPOs. The plans currently have
about 12 million enrollees.
Despite dire predictions that the
new health care law—which begins cutting government subsidies
to these plans in 2012—would
destroy the program or increase
premiums, neither has happened,
at least not yet.
Almost all beneficiaries will have
access to a Medicare Advantage
plan in 2012, except in 31 counties
in rural Colorado, Utah and Idaho,
and in many places there are
dozens of choices. Premiums will
fall an average 4 percent, benefits
remain “robust” and enrollment in
the plans is projected to rise by 10
percent, Medicare officials say.
For example, in the highly
competitive Medicare Advantage
market in Miami, beneficiaries
will have a choice of 47 plans that
include prescription drug coverage (two more than this year), and
34 of these charge no premiums,
compared with 25 this year. Across
the state, premiums fell by 26
percent on average, according to
Sen. Bill Nelson, D-Fla. “This should
be welcome news for the seniors
who were scared into thinking they
were going to lose benefits or see
higher premiums,” he said.
“poor” to five for “excellent”—
according to a range of quality measures such as customer service.
In 2012 four plans will carry the
gold star: the MedicareBlue Rx
Standard and Premier plans in six
states (Iowa, Minn., Mont., Neb.,
N.D. and S.D.) and the Rx1 and Rx2
plans in N. Y.
If enough beneficiaries take advantage of it, the system could act
as an incentive for poorer-perform-ing plans. “Plans that do a better
job serving the needs of their Medicare members should be rewarded,
and all plans should be encouraged
to improve their performance,” says
Jonathan Blum, Medicare’s deputy
Going for the Gold
Until now, people enrolled in
Part D drug plans and Medicare
Advantage plans have been able
to switch plans only during open
enrollment, except in special circumstances.
In 2012 they’ll be able to switch
once a year at any time of the
year if they choose a plan that
has earned Medicare’s top five-star quality rating. These plans
are highlighted by a gold star on
Medicare’s plan finder website at
For several years, Medicare has
rated all its drug and health plans
with stars—ranging from one for
of $8 or less for this drug, whereas most have copays in
the $30 to $45 range, and 12 plans do not cover it at all.
; Plavix: In California, copays for Plavix 75 mg, used
to prevent heart attacks, range from $35 to $90.42 for
a 30-day supply. Of the 33 plans offered, most charged
copays between $40 and $50, and eight plans charged
$70 or more.
; Zyprexa: In New York, copays for the antipsychotic
drug Zyprexa 5 mg range from $34 to $163.98 for a 30-
day supply. Of the 29 plans offered, 10 plans charge copays of under $90 for this drug, 19 plans charge $90 or
more, and seven plans charge more than $115.
Such huge disparities in copays for the same drug
are common because each plan decides its own copay
structure and makes its own trade-offs. Some plans
charge fixed dollar amounts for copays. Others charge
a percentage of the drug’s cost— 25, 33 or even as high
as 53 percent in a few cases. Paying a percentage rather
than a flat copay for expensive drugs explains some of
the highest prices shown in the examples above.
cost. You can also call the Medicare help line at 1-800-
633-4227 and ask a representative to do this search.
Of course, costs aren’t always the only consideration.
On the plan finder you can find out what kind of service
to expect from any plan by looking at the quality ratings
Medicare gives it. If you travel a lot, you can see which
plans offer nationwide pharmacies. Also, if you don’t
take any drugs right now, the plan with the lowest premium will give you coverage at the least cost.
For the Bulletin’s guide
to Medicare, go to
Finding your best deal
So how do you figure out what you’ll pay for your own
unique set of medications?
The most effective way is to use Medicare’s online
plan finder program at medicare.gov. If you enter your
ZIP code, the names of the drugs you take plus their
dosages and how often you take them, this program automatically does the math to find the plan in your area
that covers your drugs at the least overall out-of-pocket
More ways to save in 2012:
; Savings in the Part D doughnut hole: The manufacturers’ discount on brand-name drugs in the coverage gap known as the doughnut hole continues to be
50 percent in 2012, but the government discount for
generic drugs goes up from 7 to 14 percent.
; More generics will become available: Cheaper
generic copies of some expensive, blockbuster drugs
such as Lipitor, Plavix and Zyprexa will come on the
market in 2012. The original brand-name drugs, however, typically retain their high prices when this happens.
; Low-cost drug coverage: About 2 million people
who are eligible for subsidized coverage under Part
D’s Extra Help program are not enrolled, according
to Medicare estimates. “The eligibility requirements
are more flexible than they were a couple of years ago,”
says Medicare administrator Don Berwick. “If you were
turned down in the past due to income or resource levels, you should reapply.” To apply, call Social Security
at 1-800-772-1213 or go to ssa.gov. ;