We’re two weeks into the open enrollment period of Part D Medicare Drug Plans and it is my deepest hope that if you are a Medicare enrollee then you are taking time to find the best plan. It’s not easy. Finding the right plan, however, could mean getting the medications you need to stay healthy, saving money, and avoiding lots of headaches throughout the year. Our website, MedicareDrugPlans.com, gives you basic information, such as premiums, deductibles and coverage levels, but also ratings and reviews about Part D plans that can inform you about the experiences of your peers in using the different plans. Your final search should be with the government’s website – Medicare Plan Finder – where you can find the plans that cover the medications you are already taking now and specific costs related to those plans. Below are key points about costs and coverage.
Part D Plan Costs
Plan costs have gone up this year. The deductible cap increased by 12.5%, from $320 to $360. Fifty-three percent of the plans are charging the full deductible, while the other 47% charge less. Average premiums have increased from $36.68 in 2015 to $41.46 in 2016. The lowest monthly premium is $6.80, that’s if you live in Puerto Rico and choose the Humana Preferred Rx Plan. The highest premium is $174.70, that’s if you live in Florida and choose Blue MedicareRx Option 2.
Part D Plan Choices
The overall trend of having fewer Part D plans to choose from continues this enrollment season, down to 886 this year compared to 1001 last year. Looked at historically, the declines are even more striking, as there were 1,875 plans in 2007. These numbers are the totals available in all states and U.S. territories but options are really state-based. Alaskans had only 19 plans to choose from, compared to a high of 29 in West Virginia and Pennsylvania.
Part D Plan Coverages Phases
There are four coverage phases for Part D plans: deductible, initial coverage period, the coverage gap, often referred to as the “donut hole,” and catastrophic coverage. The deductible is pretty straightforward–you pay the full cost of your medications up until that dollar amount, which can be as high as $360. During the initial coverage period, you usually pay about 25% of drug costs and the plan picks up 75% until total costs have reached $3,310. At that point you’re in the coverage gap, but you’re paying discounted prices, 45% and 58% of brand and generic drug costs, respectively. Once total costs have exceeded $7,515, you are in catastrophic coverage territory, and only have to pay 5% of your total drug costs until the next year begins.
Understanding these generalities about Part D plans is important, but the devil is in the details, which can only be understood through research. It’s not enough to just stick with the plan you have. Nine out of 10 Medicare enrollees do not change plans, and many end up with higher drug costs because they don’t. The landscape of plans changes every year; so do your research, shop around, and get the best plan for your health and wallet!
For a thorough plan analysis see Kaiser Family Foundation.
For ratings and reviews, check out www.medicaredrugplans.com.
To finalize your decision go to Medicare Plan Finder.
Tagged with: donut hole, Kaiser Family Foundation, Medicare Drug Plans, Medicare Part D, medicare plan finder, Medicare.gov, medicaredruglans.com
Your prescription drugs will never be free under Medicare Part D. The “closed” donut hole under Obamacare does not create a new coverage period under Part D during which your co-pays and co-insurance, not to mention deductibles and premiums, disappear. That’s not a reason to complain. We should shoulder costs for our healthcare, including medication, as long as they are affordable (after all, Obamacare is actually called the Affordable Care Act). So how does Obamacare strive to help you afford your prescription drugs if you’re on Medicare? First, a little history…
In the beginning, Medicare did not offer a prescription drug benefit and tens of millions of seniors paid for their medications entirely out-of-pocket. Let there be light: In 2003, Congress passed the Medicare Modernization Act, which was then signed into law by President Bush. That law gave birth to Part D – a prescription drug benefit available to Medicare enrollees. But there were holes! When Medicare Part D plans first launched in 2006, average monthly premiums were $25.93. After paying a standard deductible of $250, enrollees paid 25% of their drug costs until total drug costs (between the enrollee and insurer) reached $2,250. That’s $250 towards the deductible, $500 in cost-sharing, plus premiums of $311.16 for a total of $1,061.16 per year in out-of-pocket spending. That’s if you stayed out of the donut hole!
Enter the dark days of the “donut hole,” which, in 2006, meant 100% out-of-pocket spending between $2,250 and $5,100 – Ouch! Above $5,100 – an amount called, for good reason, “catastrophic costs” –enrollees only paid 5% of their drug costs. Part D maintained these basic components, except with rising costs in the form of higher premiums and deductibles, and a larger “donut hole,” until the passage of the Patient Protection and Affordable Care Act in 2010 – enter Obamacare (hope and change?).
Tagged with: donut hole, Medicare Part D, Obamacare
Today is the last day for the Medicare Part D open enrollment period. For most Medicare enrollees, those who do not have a plan by midnight tonight will face a penalty charge, which will be added to future Part D monthly premium payments.
The Medicare drug plans have certainly frustrated many seniors, who’s experiences can be found in the ratings and reviews on www.MedicareDrugPlans.com. Some of the most frequent problems with plans communicated by seniors are drugs being dropped by plan formularies mid-year; information on drug coverage was not initially made clear; co-pays were higher than expected; and customer service was often inadequate.
On the other hand, some seniors were completely satisfied with their plans. The bottom line is that you need to pick a plan now or you will pay more later.
Sharing her optimism for Medicare Part D benefits, and the discounts provided under the Affordable Healthcare Act, Secretary of Health and Human Services Kathleen Sebelius commented on Medicare.gov’s official blog: “Through the end of October, 2.65 million people with Medicare have received discounts on brand name drugs in the donut hole. These discounts have saved seniors and people with disabilities a total of $1.5 billion on prescriptions – averaging about $569 per person.”
If you’ve yet to choose your plan, you can easily compare reviews on MedicareDrugPlans.com before making the final decision. If you want to share your experiences with others then please rate your plan.
Tagged with: Affordable Healthcare Act, co-pays, customer service, discounts, donut hole, formulary, Kathleen Sebelius, Medicare, Medicare Drug Plans, Medicare.gov, medicaredrugplans.com, Open Enrollment, Part D, penalty, premiums, Secretary of Health and Human Services, seniors