Are You Spending More On Drugs?

Are You Spending More On Drugs?

Is there a pile of marketing mailers on your kitchen table? It must be the Annual Election Period (AEP), commonly known as Open Enrollment. Between October 15 and December 7, the AEP affords Medicare beneficiaries an opportunity to change Medicare Advantage or Part D plans.

Why would I want to change plans? Perhaps the premium of your Medicare Part D plan is increasing in 2015. In California, of the 28 stand-alone Medicare Part D plans renewing for next year, 19 plans have increased premiums but 9 have decreased premiums. In addition, there will be 3 new plans. The premium is only one of many factors beneficiaries should consider in deciding whether to switch plans. In comparing costs, a better indicator is the estimated annual drug costs, which include the premium, deductible, copayment/coinsurance for drugs covered by your plan, and cost of drugs not covered by your plan.

How would I know if my plan’s copayments and/or coinsurance are increasing or if benefits are decreasing? Information is in the Annual Notice of Change that plans are required to send their members by September 30. Many beneficiaries do not read or open the Annual Notice of Change, which may be lost in the piles of marketing mailers from Medicare plans. Studies show that only a small percentage of beneficiaries review their options, and an even smaller percentage change plans.

I have stayed with the same plan year after year because the thought of comparing options is overwhelming and makes me anxious. Perhaps you don’t know about other options. Or you’re not confident that information you received is reliable.

Is there a free, reliable source of objective information that provides guidance on making comparisons? In California, local HICAPs (Health Insurance Counseling & Advocacy Programs) provide unbiased information about Medicare and related healthcare coverage to Medicare beneficiaries, their families and caregivers. Comparing Medicare Part D plans is a service in high demanded during Open Enrollment. Other services include:

  • Comparing Medicare Advantage plan options;
  • Comparing Medicare Advantage to Medigap; and
  • Enrolling in low-income assistance programs.

Many HICAPs help beneficiaries find plans that meet the beneficiary’s needs and save costs. In fiscal year 2012-13, HICAPs saved almost $21 million for 13,124 beneficiaries. HICAP is a state-administered program and does not charge for its services. Find the HICAP that serves your county or call 1-800-434-0222.

You may also call 1-800-MEDICARE (1-800-633-4227) to help you find, compare and enroll in plans. The 1-800-MEDICARE call center is open 24/7. TTY 1-877-486-2048.

If you like to make you own plan comparisons, you may find the Medicare Plan Finder helpful. The Medicare Plan Finder is a tool that helps you compare Medicare Advantage and Part D plans. If you enter the medications you need, the Medicare Plan Finder will provide a list of Medicare prescription drug plans that cover your medications with details to help you make an informed decision, such as:

  • premium
  • estimated annual drug costs
  • deductible
  • copayment or coinsurance for each drug
  • whether your drug is subject to prior authorization, step therapy or quantity limits
  • whether you will get into the “donut hole” and, if yes, when
  • pharmacies in the plan’s network
  • mail-order pharmacy service

Perhaps after comparing other options you may find that the plan you’re in best meets your needs. Or you may find one or more plans that better meet your needs, like covering all your medications and or saving costs. You have until December 7 to change Medicare Advantage or Part D plans. Any change you make will be effective January 1.

See our Annual Election Period page for more information on Medicare’s Open Enrollment and commonly asked questions and answers.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.