Bill, a Medicare beneficiary in his early 80’s, signed up for a Medicare Part D plan when the program launched in 2006. His Part D plan, one of three offered by a company, had the highest premium. Even though the premium increased each year, he stayed with the same plan because he found it a daunting task to compare cost and benefits.
Bill is in good company. Studies show that as many as 9 out of 10 beneficiaries stay with their plan. Last year, Bill happened to mention his cost for prescription drugs, including his Part D plan’s high premium, to a friend. The friend happened to be affiliated with the State Health Insurance Assistance Program (SHIP, called the Health Insurance Counseling and Advocacy Program or HICAP in California) and helped Bill review his options. The friend found that the company offering Bill’s Part D plan offered two other plans with lower premiums. The plan with the lowest premium also covered Bill’s medications but at lower cost-sharing amounts. Bill changed plans, saved more than $30 a month in premium costs and paid lower cost-sharing for each prescription in 2015. He is no longer hesitant to review his options.
There will be 28 stand-alone Part D plans available in California in 2016. All 28 plans are renewing from 2015. Some reports point out that the national average increase in Part D plan monthly premium is almost $5. In California, 22 of the 28 plans have increased premiums, ranging from an increase of $0.90 to $98.70. Five plans have decreased premiums, ranging from a decrease of $0.50 to $50.40. In one plan, the premium remains the same.
| Part D Plans with Premiums Decreasing in 2016 | 2016 | 2015 |
| Express Scripts Medicare – Choice | $100.10 | $103 |
| Express Scripts Medicare – Value | $60.60 | $62.40 |
| First Health Part D Premier Plus | $91.90 | $104.40 |
| First Health Part D Value Plus | $37.60 | $38.10 |
| Symphonix PrimeSaver Rx – formerly Symphonix Rite Aid Premier Rx | ||
| Plans with Smallest Increase | 2016 | 2015 |
| SilverScript Choice | $23.10 | $22.20 |
| Plans with Biggest Increase | 2016 | 2015 |
| Transamerica MedicareRx Classic | $131.50 | $32.80 |
We encourage beneficiaries to review their plan for changes in costs and benefits. The premium is only one cost; other costs are the deductible, copayment and coinsurance. A beneficiary should check if his or her medication will continue to be in the plan’s formulary and, if yes, what will the cost-sharing be? Will the plan have a deductible in 2016? If yes, how much? Information about a plan’s changes is in the Annual Notice of Change which beneficiaries should have received by September 30, 2015.
Another factor to compare is a plan’s star ratings, which were released in early October on the Medicare Plan Finder for 2016 plans. Plans are rated on a 5-star system. Plans rated 4 to 5 stars are high-performing plans whereas plans with fewer than 3 stars are low performing plans.
HICAP, the Medicare benefits counseling program, is available to help beneficiaries find and compare options. HICAP’s statewide toll-free number is 1-800-434-0222. Beneficiaries can also find and compare options by using the Medicare Plan Finder on the official Medicare website at medicare.gov or calling 1-800-MEDICARE (1-800-633-4227).
