Medicare Health and Drug Plans: Are You Paying Too Much?

Author: The Senior Citizens League
Published: 2020/09/30 - Updated: 2023/09/13
Publication Type: Informative
Topic: Disability and Retirement - Publications List

Page Content: Synopsis - Introduction - Main

Synopsis: Chances are high that most retirees are paying too much for their Medicare health and drug plans, says The Senior Citizens League (TSCL).. The consequences of making the wrong choice can be very expensive, but virtually every area of the country has trained Medicare benefit counselors who work through State Health Insurance Assistance Programs (SHIP)

Introduction

With 1.2 million supporters, The Senior Citizens League is one of the nation's largest nonpartisan seniors' groups. Its mission is to promote and assist members and supporters, to educate and alert senior citizens about their rights and freedoms as U.S. Citizens, and to protect and defend the benefits senior citizens have earned and paid for. The Senior Citizens League is a proud affiliate of The Retired Enlisted Association.

Main Item

"Unless you match your needs to the lowest costing plan that specifically cover the drugs you take, or Medicare Advantage plan that includes the doctors and hospitals that you typically use in its network, you could be needlessly spending hundreds of dollars too much for your coverage," says Mary Johnson, a Medicare policy analyst for The Senior Citizens League. "For married couples, this can mean different health or drug plans for each of you," she notes. Yet surveys conducted by senior advocates, including The Senior Citizens League, indicate that only a small portion of Medicare beneficiaries ever shop around for better coverage at the lowest cost.

Prescription drug costs are the fastest growing expenditure that most people face in retirement, according to research by The Senior Citizens League.

"Most retirees have other options that they don't even know about," Johnson says.

Medicare's fall Open Enrollment period, which starts October 15th and runs through December 7th, is the time to learn about those other options, and to make changes to health and drug plan coverage.

"Drug and health plans change every year, and so does our health," Johnson notes. Since 2005, Johnson has volunteered as a Medicare counselor in her underserved area to help neighbors, friends and family navigate through dozens of choices, and to get matched up to optimal health and drug plans. "It's not uncommon to save hundreds of dollars in a single year," she says.

In 2019, out-of-pocket costs for prescription drugs averaged more than $3,875 for the year, and that cost is growing by double digits. According to research by Johnson, out-of-pocket prescription drugs costs have increased 252 percent (about 12.6 percent per year) since 2000. "Nobody should be complacent and swallow that kind of increase" Johnson says. "This is not as difficult as it may seem," Johnson says. "There are people like me ready to help." Here are a few tips from Johnson on how to find better coverage:

• Make it easy. Get free unbiased help. The consequences of making the wrong choice can be very expensive, but virtually every area of the country has trained Medicare benefit counselors who work through State Health Insurance Assistance Programs (SHIP). Many of these programs operate through local agencies on aging. Call early and make an appointment. Counseling can be safely done over the phone.
• Use the Medicare drug and health plan finder tool. Be careful what you Google. Just entering "Medicare drug plans" can pull up a mares' nest of web sites peddling plans, but what you want is complete information for the county where you live. Rather than bog yourself down trying to compare plans on two or three different sites, stick to Medicare. All the drug and Medicare Advantage plans serving your county will be listed. You can select your choice by the drugs, and healthcare providers that you use. If you decide to switch from your current plan, it is important to double-check the information listed on Medicare.gov first, and to switch using Medicare's enrollment tools. That will ensure that your enrollment information goes to the plan of your choice, and that your former plan is automatically notified of your disenrollment.
• Search by the drugs you take and include drugs you only use occasionally. If you have not already got one, make a complete list of the drugs you currently take. Do not try this from memory; read labels, because spelling is important. Check the dosage and quantity that you take daily and monthly. A 90 - day supply is often less expensive per dose than a 30 - day supply, so consider getting your refills that way - especially for generics. Drug prices can vary considerably. The difference in price, particularly for brand name drugs, can be in the hundreds, or even thousands, of dollars.
• Look for plans that provide coverage before the deductible. The standard deductible for drug coverage in 2021 is $445. That is a lot, when the average monthly Social Security benefit is just $1,500. But you might be able to save that much or even more if you are willing to go for the plan with the lowest costing premiums and out-of-pocket costs based on the drugs you actually take. In addition, many plans offer low or zero co-pays for preferred generics "before the deductible," meaning you will only have to pay for brand and non-preferred generics during the deductible phase of coverage.
• Compare the least expensive way to fill prescriptions, especially comparing the difference between different retail pharmacies and mail order. It makes absolutely no sense, but even drug plans offered by the same insurer vary significantly in drug costs. Often, the difference between plans offered by the same insurer depends on the pharmacy where you fill your prescription (such as CVS vs. Walmart or Walgreens) or retail pharmacy vs. mail order. One job when comparing plans is finding the best places to purchase your prescriptions, and that can vary by the prescription. For example, you may take several common generics that you may be able to fill at zero co-pay by mail, but there is likely to be a small co-pay at retail pharmacies. You may have one or more brand name drugs that would be less costly from a retail pharmacy than by mail (or vice versa). When you have narrowed down your drug plan search, take your drug list that you made when you started, and make notes of whether the best price of the drug will be by mail order, or list the specific retail pharmacy and the estimated co-pay. If you do switch plans, you may need to ask your doctor to call in your prescription to a different pharmacy.
• If diabetic, look for new Medicare drug plans that offer a maximum $35 copay for insulin. Some 2021 drug and Medicare Advantage plans across the country may offer different types of insulin at a maximum co-pay of $35 per month in 2021. This includes all stages of coverage, including the deductible, initial coverage, and the coverage gap. This coverage is only offered to people who do not otherwise qualify for Medicare Part D low-income subsidy or "Extra Help," and may not be available in all areas of the country. But check.
• If two plans are similar in costs check the general co-insurance for non- preferred generics, brand, and specialty drugs, even if you do not currently take any. Take the plan with the lowest costing non-preferred cost sharing.

Attribution/Source(s): This quality-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by The Senior Citizens League and published on 2020/09/30, this content may have been edited for style, clarity, or brevity. For further details or clarifications, The Senior Citizens League can be contacted at SeniorsLeague.org NOTE: Disabled World does not provide any warranties or endorsements related to this article.