Category: Formulary

Turning 65? We Can Help You Choose the Right Medicare Route

Here’s what you need to know about Medicare plans

Choosing the right Medicare plan is a big decision, particularly if you won’t have retiree coverage under an employer-sponsored plan. Medicare is complex and can be quite confusing. So making the right choice for your budget and health needs is as important as your decision when to retire.

First, there are two main roads to consider in choosing Medicare coverage, so it’s important to determine your needs before making a decision. It’s equally important to compare the various plans available in your region to ensure they fit your budget as well as meet your medical and prescription drug needs.

You can choose to take either Original Medicare or a Medicare Advantage Plan (Part C). Both routes include Part A (hospital insurance) and Part B (medical insurance) coverage. Either way, you will need to make sure you are eligible and/or sign up for Parts A and B. The best way to do this is to call Social Security directly. At the same time, you will need to decide if you want Medicare Part D coverage, either as a stand-alone Part D plan or as part of a Medicare Advantage Plan. Let’s take a closer look at both choices in this chart.

Now that you’ve reviewed this information, you might have a better idea of which option is right for you. The information below should help you make a more educated decision.

Consider Original Medicare and a Stand-Alone Part D Plan If You:

  • Wish to have more choice and access to a larger network of health providers and facilities
  • Have supplemental coverage from an employer to cover some costs and services Medicare does not cover
  • Do not mind coordinating coverage from multiple providers
  • Can buy a Medigap policy from a private company to help pay some of the costs that Original Medicare doesn’t cover, like copayments, coinsurance and deductibles. All Medigap plans pay 100% of your Part A coinsurance and hospital costs after your Medicare benefits are used. Depending on the type of Medigap plan you buy, additional benefits may include:
    • 50% – 100% of your Part B coinsurance or copayment
    • 50% – 100% of your Part A hospice care coinsurance or copayment
    • 50% – 100% of the coinsurance for skilled nursing care
    • 80% of your costs for a travel emergency outside the U.S.

Consider a Medicare Advantage Plan If You:

  • Like the convenience of having just one provider instead of coordinating coverage from multiple providers
  • Prefer a plan that is similar to what you may receive from an employer
  • Want to purchase a plan that covers additional services not available through Medicare, such as vision, dental and hearing plans
  • Are willing to use in-network doctors and medical facilities like in an HMO or PPO
  • Are not concerned about having coverage when traveling outside the U.S.

Medicare offers a lot of choices. Finding the best route takes a bit of research to make sure you’re on track for making the right decision for you.

If a Medicare Part D plan is the right route for you, we have four simple rules to help you have a smoother ride! Watch this video to learn more.

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Road Hazards: High-Risk Medications

Are you taking a high-risk medication? Here Is what you should know

As a pharmacist, I know the life-saving potential of every medication on the market. But even the safest and most effective medications have some effect on your body beyond just their intended purpose. Some medications come with side effects, limited effectiveness, and other concerns that may make a drug more risky than beneficial for an individual. This risk can be made worse by taking certain medicines together.

A listing called the Beers Criteria (named for the scientist who developed it) identifies these medications. They are known as high-risk medications (HRMs), potentially inappropriate medications (PIMs), or drugs to avoid in the elderly (DAEs).

There are several reasons why you may be prescribed a HRM:

  • You may have multiple doctors prescribing medications that are safe on their own, but have increased risks when combined with other medications.
  • You may have been prescribed the medication years ago and are continuing use it past a safe stage.
  • Your doctor may have determined that the benefits outweigh the risks for you and other patients.
  • Safer medications may be more costly or less available.
  • There may not be effective alternatives available.

 

How Can I Avoid Potentially High-Risk Medications?

Drug safety starts with awareness. Keep track of all medications you’re taking and make sure your doctor has access to the list before he/she prescribes you any new medicines. Be willing to ask questions, and don’t be afraid to say something if you’re unhappy with a prescribing decision. If you’re helping a loved one manage his/her prescriptions, be sure to keep up to date on the medications and help avoid the use of any potentially risky new medicines.
It’s important to always use your prescription benefit card — even when buying medications that aren’t covered by your plan or are available over the counter. By doing so, potential drug interactions can be tracked and pharmacists can help prevent harm to the patient.

What Should I Do if I’m Prescribed a HRM?

First, you should talk with your doctor or pharmacist about potential alternatives. If it’s deemed that the HRM is still your best option, take note of the possible risks and side effects. If you feel that you’re experiencing any issues, don’t hesitate to reach out to your doctor to see if there’s another alternative for you.

While these drugs could pose an increased risk at times, they can and do help people. By being proactive and aware of potential benefits and risks of each medicine, you can make an informed decision with your doctor about whether a medication is right for you.

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