As a volunteer counselor for a State Health Insurance Assistance Program (SHIP), I speak every week to Medicare beneficiaries who have questions about their Medicare benefits or need help selecting plans for their Medicare coverage. Medicare’s open enrollment period runs through December 7 — this is the time that beneficiaries with a Medicare Part D prescription drug plan or a Medicare Advantage plan learn about the changes to their plan for the coming year.
Recently, I talked to a beneficiary whose Part D drug plan sponsor notified her that her current plan was being discontinued and that she would be transferred to a plan from the same company. It would mean her monthly premium would jump from $24 to $58. The notice about this upcoming change convinced her to explore her options for changing plans. She turned to the Medicare Plan Finder: after inputting her personal and medical information, including the eight drugs she takes, she saw that switching to a different plan, rather than going along with the scheduled plan transfer, would save her a little over $1,000 in 2022.
Unfortunately, my client is the exception, not the rule. Unlike most people, she took the time to ask questions. A recent study showed that 72% of Medicare beneficiaries don’t explore their drug coverage options during open enrollment. As a result, they don’t switch to a lower-cost plan. Other research has shown that many beneficiaries are not in a Part D drug plan that represents the lowest cost for the particular drugs they take. Too often they are unaware that switching to a different plan could save money.
If it were just a matter of money, that would be unfortunate. But the consequences can be greater. When the cost of drugs is higher, some people skip taking some of their prescribed drugs or take them less often than prescribed. These decisions can have consequences for their health.
What should a Medicare beneficiary do if they want to save money and improve their coverage? Doctors should advise their patients on Medicare to go to the Medicare Plan Finder, where they can set up a My Medicare account and enter the drugs they take and the pharmacy they use. The Plan Finder will then show them which plan has the lowest total cost for the coming year, including both their monthly premium and the copays for the drugs they take. Of course, this selection is based on their current drugs, and it can be challenging to anticipate future changes to their drugs.
They also may be able to find a lower price by considering different pharmacies because each drug plan has preferred pharmacies that offer the lowest prices to the consumer. If a beneficiary is not comfortable doing their own online research, maybe a friend or family member can help them. Importantly, anyone can reach out to a local SHIP counselor. SHIPs are state-run programs that provide one-on-one unbiased help, and beneficiaries can look online to find a phone number for their state. Another option is to call the Medicare helpline: 1-800-Medicare.
Sometimes beneficiaries ask their physician or pharmacist for help, but these professionals may not be experts in researching plan choices. Oftentimes, the most important role they can play is directing patients to resources created specifically for this purpose. In other cases, some people use insurance agents or brokers to help find a plan. Although brokers and agents can be valuable resources, it is important to understand that they may not represent all the available plans and thus may not identify the one that is best for a particular person.
While my volunteering is focused on helping Medicare beneficiaries, they are not the only people who would benefit from doing some homework. Consumers who purchase insurance on the Obamacare marketplaces also have the opportunity during the annual open enrollment period to look for a plan with better coverage or a lower premium. And many workers also have a choice of plans each year.
It is easiest for consumers to stay with the coverage they have. But encouraging patients to invest a little time to find better options can yield substantial savings and can contribute to better health outcomes.
Jack Hoadley, PhD, is Research Professor Emeritus in the Health Policy Institute of Georgetown University’s McCourt School of Public Policy.
Source: MedicalNewsToday.com
