Fall is right time to rethink your Medicare drug plan options

Fall is right time to rethink your Medicare drug plan options
From Reuters - October 5, 2017

CHICAGO (Reuters) - Forewarned is forearmed - and for U.S. seniors, the warning just arrived in the mail.

Each September, enrollees in Medicare prescription drug and Advantage plans receive letters from their insurance companies detailing any changes in coverage for the year ahead. Called the Annual Notice of Change, the document is well worth reviewing, because it arrives just ahead of the annual fall plan open enrollment period, which runs from Oct. 15 to Dec. 7.

In many cases, the letter should be a wake-up call to re-shop coverage, especially where Part D drug plans are concerned. These plans often change their premiums from year to year, along with their rules for cost-sharing, coverage of specific medications - and even whether a specific drug will be covered.

Medicare eligibility begins at age 65, and the first choice is between traditional Medicare and an Advantage plan, an all-in-one managed-care alternative that usually includes prescription drug coverage. Advantage plans also cap out-of-pocket expenses. Seniors who choose traditional Medicare usually add a standalone drug plan; many also add a Medigap supplemental policy. But all drug coverage features can change annually, and Advantage plans can make changes to their networks of healthcare providers at any time.

What worked for you in the past wont necessarily be best for you in the future, said Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center, a nonprofit consumer advocacy group. Its important to look at your options and evaluate whether you should switch plans.

Few Medicare plan users re-shop their coverage, and those who do tend to focus only on premiums, said Schwarz. People often mistakenly just choose the least expensive premium, or one that is middle-of-the-road.

She urges people also to evaluate the network of providers - pharmacy delivery options in the case of standalone drug plans, and healthcare providers in the case of Advantage plans. Also read carefully the so-called formulary, which describes the rules for coverage of a medication - whether any quantity limits are imposed, or if the red tape of prior authorization will be invoked.


Drug plans are becoming more complicated. Most have deductibles, and just over half will charge the full amount permitted under Medicares rules ($405), according to the Kaiser Family Foundation (KFF). And most plans have shifted to using multiple copayment (flat fee) or coinsurance amount (percentage of total cost), rather than a single coinsurance rate. This is especially true for high-cost medications.

Cost-sharing was more simple in the early days of Part D, said Juliette Cubanski, associate director of the program on Medicare policy at KFF. Higher coinsurance rates could leave enrollees with substantial out-of-pocket costs, especially for high-cost specialty drugs.



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