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Carol Bradley Bursack, Published October 08 2011

Bursack: Check all options for Rx

Dear Carol: How do I determine whether or not my parents are receiving the best prescription benefits?

Yesterday I went to the drugstore to pick up their medications, and the co-pays totaled over $700. My parents’ health insurance, which is through Dad’s former employer, partially pays for prescriptions. My parents also have Medicare, but I’m not sure what it covers. How do I know if their Medicare covers prescriptions? – David

Dear David: Your question comes at a perfect time, as Medicare open enrollment, which is the time for people to make changes in their coverage, starts Saturday and ends Dec. 7.

Increasingly, many employers have reduced the amount they pay for employee medical coverage. You may want to investigate whether it’s financially worthwhile for your parents to carry the former employer’s insurance, since they are on Medicare, as well. What generally happens in these cases is that the employee insurance pays first and the remaining amount is covered by Medicare.

Basic Medicare only helps with prescription costs if your parents carry Medicare prescription coverage through Medicare Part D. Medicare Part D has a prescription coverage gap. For 2012, this coverage gap (donut hole) should start when enrollees reach the initial coverage limit, which is estimated to be $2,930 out-of-pocket, and should end when they have spent $4,700. Then, the insurance kicks in again. There is a Medicare Advantage option, as well. It’s more expensive, but you may want to ask about this so you are informed.

If I were you, I’d start online at www.medicare.gov. After getting your feet wet, you can call the phone number provided and ask them to explain how Medicare works as a secondary insurer. They will likely tell you that in order to obtain prescription coverage for your parents, you will have to find a Medicare Part D provider in their location. There is a plan finder on the website to help you find which company in their area covers the most drugs that your parents currently take.

Next, find out what your dad is paying for his work-related insurance. If he is paying a high premium for that coverage, plus has Medicare B and supplemental coverage for doctor visits, he may be paying much more in premiums than if he chose to only go through Medicare with enrollment in the various plans, including a supplemental plan and a prescription drug plan.

The main thing to do is get Medicare counseling through the Medicare office during open enrollment, so start now. Once you are well informed, you can decide what type of insurance combination is the best option for your parents.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.