By Mary Nugent, Chico Enterprise-Record

POSTED: 08/12/16, 4:19 PM PDT | UPDATED: 2 DAYS AGO

Don’t guess: Medicare’s Part D needs some explanation


Chico >> Medicare’s annual election period begins Oct. 15. Seems like a ways away, but it’s not too soon to begin considering the tons of choices out there.

Part of those choices involve Medicare Part D, the prescription drug plan.

“I encourage all seniors on Medicare Part D to have their current plans reviewed to ensure that plan is still covering their drugs for the next year, and at the cheapest rate,” said Ronda Kramer, director of the Health Insurance Counseling and Advocacy Program, under the umbrella of Passages, a senior resource center in Chico.



“All Medicare Part D plans have some sort of change every year, from co-pays, deductibles, tiers, premiums and formularies.”

Just some of those terms — tiers and formularies — are reason enough to get advice from people who understand the daunting process.

“HICAP is the local Medicare advocate office and we are here to assist beneficiaries free of charge,” Kramer said.

The agency’s staff and volunteers have helped thousands of seniors choose health care plans and save money.




“There are 65,000 Medicare beneficiaries in our five-county area. Last fiscal year, we did 3,100 one-on-one counseling appointments; 2,809 booths and exhibits; 123,634 targeted persons were reached; and we met 1,254 people in workshops.



“We have saved in five counties more than $1.5 million for (Medicare) beneficiaries. We offer good advice and be sure they’re not spending unneeded funds.”

Kramer recently took time to share her views about prescription drug plans in response to a press release received by this paper from the California Society of Certified Public Accountants.

“Americans laid out an estimated $457 billion on prescription drugs in 2015, according to the U.S. Department of Health and Human Services, up about 8 percent from 2014. And one-third of Americans reported facing recent hikes in their prescription costs, a Consumer Reports study found,” according to the press release.






The press release advised checking out-of-pocket prices for prescriptions, and to ask a pharmacist what the cost would be without insurance.

“That can be true, but be careful,” Kramer said. “Seniors need to know there are other options. Most importantly, to confirm that the prescription plan they enroll in is contracted with the pharmacy they choose and if a drug is not covered by their plan they can work with the prescribing physician to get an exception with the plan. You’d be surprised how many people don’t know that.




The Society of CPAs also suggested comparing what different pharmacies charge for the same medication.




Many drug companies, the society’s press release said, offer discount programs for those who can’t afford their medications.

“Here at HICAP, we assist beneficiaries with applying for Extra Help, a low-income subsidy through Social Security which lowers prescription cost substantially for those who are lower income but still do not qualify for MediCal.

“People may be lower income, but what they make is too high for MediCal. A lot of people get caught in between,” she said.



Kramer also said that prices for generic drugs can rise, too. She encouraged people to talk with their doctors. “Bring your plan so he can see what’s covered. He may manipulate the prescription you take. There are a lot of options.”

When it comes to prescription drug plans, veterans are their own category. “If they are eligible for veteran’s benefits, their drugs are $9 a prescription, whether they’re on Medicare or not,” she said.

Kramer had another suggestion. “People can seek assistance through the manufacturer through Patient Assistance Programs and you get that information from the drug manufacturer’s website or by calling them directly.”



Besides help with prescription drug plans, HICAP’s trained volunteers assist people in understanding Medicare, or resolving problems with benefits; compare Medicare supplemental insurance or health plans; and explore long-term care options.