As a retired physician who is inundated with questions by friends and relatives, I read with interest “Are You Ready for Medicare Part D?” [January 2006]. While I found your discussion valuable, there seems to be one glaring flaw. The article discusses the $850 threshold, or the point at which a plan with a $37.50 monthly premium would pay for itself. The $850 threshold is a useful barometer, but the decision is far more complex than this because every health plan has a different price for specific drugs. Throw in the wide pricing discrepancies that patients find when shopping locally or via the Internet, and the $850 guideline makes even less sense. For example, my father-in-law, who lives near the Canadian border, pays about 60 percent less for his medications than he would pay in the U.S. For him (and most anyone who buys on the Internet), that $850 threshold is probably closer to $2,000. For retirees on limited incomes, thousand-dollar decisions like this can be vital.

Author’s response:

The $850 figure was calculated using the standard plan as proposed by federal guidelines and, as Dr. Bird points out, may not represent the prescription drug plans available in all areas. Variability in the more than 330 plans available nationwide makes “apples-to-apples” comparisons difficult. For example, a tier-1 drug may mean a $10 co-pay in one plan and co-insurance of 50 percent in another. Also, each plan may have negotiated a different price for a given drug, so even equivalent tier systems won’t guarantee perfect comparisons.

These Web sites provide helpful information: http://www.mymedicarematters.org, http://www.medicareadvocacy.org and http://www.ncmdpartd.org.