Millions of seniors are going to have to dig deeper to pay for their Medicare benefits next year, thanks to rising costs for healthcare and medication.
AARP is warning members that nearly 10 million seniors with Medicare Part D drug policies could face rising prescription premium costs in 2015. Those enrolled in six of the 10 largest drug plans could face hikes ranging from 11 percent to 52 percent, if they don't switch to different, less costly alternatives.
Another 3.5 million members enrolled in three other large plans will see premiums drop by 13 percent to 31 percent when the new policies kick in, Jan. 1.
The projections — from Avalere Health, which tracks healthcare trends — are a critical reminder that Medicare's private plans can change their costs and benefits every year to reflect rising costs of medical care, driven in part by healthcare reform changes under Obamacare.
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Open enrollment for Medicare continues through Dec. 7, giving Medicare beneficiaries the chance to compare and contrast dozens of private drug plans offered through Part D for next year.
Experts advise seniors not to simply “re up,” and keep their current Medicare Advantage HMOs, PPOs, and Part D plans without checking to see if coverage levels, premiums, out-of-pocket costs, and doctor and hospital networks are still appropriate.
The Medicare Part B premium, which covers doctor visits and outpatient services, will remain the same in 2015 – at the current $104.90 a month, according to the Centers for Medicare and Medicaid Services.
But, as the new numbers show, some Medicare recipients could wind up paying twice as much for Part D prescription plans next year, if they don’t take care to weigh their options, notes Christine Harhaj, Avalere's senior manager.
"You could be in a drug plan in 2014 where your copay is maybe $50 and then for 2015 the plan has increased that amount to $100," Harhaj tells AARP
. "So does it still make sense for you to be in that plan? Or does it mean it's time to shop around and see what else is out there and whether you can get your drugs at a lower price?"
According to an AARP analysis, Part D plan copays vary widely, even for the same drug. For instance, the senior advocacy group noted —and can vary by more than $100 for a month's supply, For example, costs for the common insulin drug Lantus SoloSTAR will range between $24 and $170 for a 30-day supply in 2015 among 31 Part D plans offered to seniors in California. Fourteen of those plans will charge under $45 a month and eight plans bill for more than $80.
Seniors can compare and contrast plans and costs for the drugs they take by logging onto the “plan finder” feature at Medicare.gov, which automatically determines plans that cover your drugs at the lowest cost. (Seniors can also call Medicare at 800-633-4227 for help).
Those who do not switch plans are automatically re-enrolled in their current plans for 2015.
Seniors with Medicare Advantage plans — private plans that offer benefits beyond those of traditional Medicare — will also see their costs increase next year because of lower government payments tied to Obamacare.
Some health experts worry that those declining federal funds could prompt insurers to stop offering such plans or cut benefits. Some rural states – including Alaska – have already seen Medicare Advantage plans fall by the wayside, because of the higher costs of providing healthcare in such regions of the country.
Insurers are also increasing shifting the costs for Medicare Advantage plans to enrollees, by charging annual deductibles for health services. In Miami, for instance, 35 of 39 Medicare Advantage plans will charge deductibles for next year, of between $500 and $975. By contrast, none of those benefit-rich plans charged a health deductible.
In addition, while 30 Miami-based Medicare Advantage plans offered extra help in the prescription drug coverage gap – known as the so-called “donut hole” – none will provide such assistance next year.
Other changes in Part D coverage for 2015:
Drug plan options narrow: The total number of plans nationwide will drop to 1,001, the lowest since Part D began, but most state residents will still have dozens of options. Some insurance companies that offered three Part D plans in the past will consolidate to two or one. Among top plans that will go that way: AARP MedicareRx Enhanced; SilverScript Basic; Aetna/CVS. Monthly premiums range from $12.60 to $171.90; the average monthly premium will be $38.83.
Part D doughnut hole shrinking. On a positive note, in 2015, seniors will get more discounts to cover the “donut hole” gap in prescription drug coverage gap — 55 percent off the cost of brand-name drugs and 35 percent off generics. Medicare officials say that shrinking the gap is a result of the Affordable Care Act, which the Obama Administration says has saved 8.3 million enrollees more than $12 billion.
Fewer plans provide extra gap coverage. In 2014, six to eight plans in California, Florida, Illinois, New York, and Texas gave additional coverage to seniors who fall into the gap (on top of the Obamacare “donut hole” discounts), but in 2015, none will.
Drug deductibles increase. Next year, the maximum Part D annual drug deductible rises by $10, to $320. More plans will also charge a deductible (from $1 to $320) and fewer will waive the deductible.
These changes make it critically important for seniors to compare plans to get the best bang for their healthcare buck, experts advise.
"Shopping around is the best thing a Medicare beneficiary can do," says Avalere's Harhaj. "There's still so much choice in the market."
To pick a plan, experts advise the following tips:
Buy generic whenever possible. Brand-name drugs drive costs up, which makes generic drugs a money-saving alternative. But be sure to check with your doctor about the use of generics.
Compare pharmacies, use mail order. Shopping around for plans and drug costs can lead to a lower co-pay if you use an in-network pharmacy. Purchasing prescriptions by mail, or in three-month supplies, can also save you money.
Ask your doctor about free samples. The average physician receives more than $21,000 per year in samples from drug companies. All you have to do is ask for them.
Consider pill-splitting tablets. Some tablets can be cut with a pill-splitter, effectively cutting your drug costs half. For instance, if you pay a $15 co-pay for a one-month supply of the statin Zocor (containing 40 milligrams), ask your doctor to write a script for 80-milligram Zocor pills and cut them in half. That will save you $90 per year.
Investigate drug assistance programs. Look into drug assistance programs that provide free or low-cost drugs to those who meet income-eligibility guidelines. The RXAssist program — at rxassist.org/ — provides a clearinghouse of such programs.
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