Navigating Medicare prescription plans is usually a daunting and confusing procedure but this year it is even more so, according to Bill Robinson, insurance advisor at Palm Canyon Insurance Agency in Palm Springs.
“Each year drug companies change offered plans,” Robinson said. “What is so difficult is that this year so many companies are changing their drug formularies (what drugs are covered by the policy), removing some and moving others into higher, more costly tiers,” he siad. “I’m in the [insurance] business and it drives me crazy. I don’t think they [the insurance companies] could have put in place a more complicated and confusing plan.”
Original Medicare Part D prescription drug plans are offered and run by private drug companies approved by Medicare. Plans that prove too costly to drug companies are discontinued, as happened this year with a Blue Shield Premium Plan that had a higher premium than most other plans but also shaved significant amounts off copays, reducing overall out-of-pockets by more than $2,000 for most subscribers who had previously paid, at least, $4,000 when in the plan’s “donut whole.” The donut whole is a gap in coverage in which the subscriber is liable for drug costs after their plan has paid a certain amount. Those subscriber out of pockets are often more than $4,000.
When a plan is discontinued, subscribers have to wade through the details of other available plans or they are automatically enrolled in the same company’s next most comparable plan. And the plans are often significantly different from the subscriber’s previous plan. Subscribers must make these choices by Dec. 7 to avoid automatic enrollment.
What seniors must do, to avoid surprises, is run their drug regimen on the Medicare site (https://www.medicare.gov/find-a-plan/questions/home.aspx) or have an insurance agent do it for you. After doing so and discovering what is covered, what is now more expensive, and what is no longer covered in their existing plan, seniors must then select an alternate plan, evaluating the cost and benefit of premiums versus co pays for their necessary drugs.
Recently, drug companies, under pressure from the federal government, agreed to offer 50 percent discounts to subscribers for drugs covered in a Part D Drug Supplement plan. If the drug is not in a plan’s formulary, it is not covered.
If you decide to navigate Medicare waters without professional assistance, do so carefully. Create a spreadsheet to compare plans and benefits and run the numbers. To get general or claims-specific Medicare information call (800) 633-4227 or view www.medicare.gov.
Other Medicare supplements, other than Part D, change less and are more similar company to company, said Robinson. “A supplement plan F offered by Blue Shield is basically the same with regard to benefits as one from Aetna,” he said. “It’s with the Part D drug plans that subscribers must be most careful.”
Medicare is government provided health insurance for people age 65 or over, those under 65 with certain disabilities and any person with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). Recipients can elect Original Medicare, with Part A (no premium) hospital insurance and home health care services and Part B (with premium) covering doctors’ services and outpatient care. Original Medicare. Original Medicare recipients usually also choose a Part D drug plan.
