Time to Re-shop for your Medicare Part D Plan

Medicare Open Enrollment:  It’s a Date!

Why?  Because the drug companies and insurers take their deck of 52 cards every summer and toss them in the air.  They come down in a completely different configuration.  The costs of the plans change.  Your exact same drugs can cost more or less than last year.  A pharmacy that was “preferred” last year may be out of favor this coming year.  The results can hit your wallet pretty hard if you’re not willing to play the game.

So, please set aside an hour or two BEFORE Thanksgiving to re-shop for your Medicare Part D plan. 

Sadly, nearly 75% of Americans on Medicare do not re-shop for their drug plans.  (According to the latest Kaiser Family Foundation research.) And, they end up paying more.  Frankly, the insurance industry counts on you not bothering to re-shop for coverage.  Or, counting on inertia and lack of motivation to keep you in the same plan where they’ve raised prices.  Either way, you’ll just pay more when you don’t need to.

Medicare Part D is in its teenage years

If you are new to Medicare, you might not know that Part D coverage is only 15 years old.  Before 2006, those on Medicare had no help paying for their prescription drug costs. Unless they chose certain Medigap plans. Only a few gap plans offered some amount of cost sharing for prescriptions.

During the George W. Bush administration, an ugly truth came to light.  Many seniors could not afford the increasingly high costs of their drugs.  So, seniors skipped taking drugs for chronic illnesses.  They’d “modify” the dosage by cutting pills in half. And ended up using much higher hospital services. 

In a significant piece of legislation, The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 overhauled Medicare. It’s also called the Medicare Modernization Act or MMA.  One of the biggest changes was the introduction of Medicare Part D – helping Medicare beneficiaries with the cost of their drugs.

While Medicare is 56 years old, the Part D part is only 15.  And, it’s as difficult as your teenagers were when they were 15!

Be Prepared to Change Your Medicare Part D Plan Every Year

The prescriptions you take may come and go throughout retirement.  You might never take an aspirin let alone a basket of drugs.  Regardless, it would be most effective for you and your wallet to mark your calendars for every October 15^th.

Binghamton, Broome County, NY

For folks living in upstate New York, the number of drug plans has been rapidly decreasing.  Just two years ago, they had 27 plans, then 28 plans for 2021, and now down to 19 plans.  Likely, there is some consolidation among insurers.  And the smaller, unprofitable players pulled out.

The monthly premium for the lowest cost plans is ten cents less than last year.  It went from $7.30 per month to $7.20 per month.  However, the annual deductible increased $35.  So, most folks will have to pay more out of pocket before they get help from their insurance plan.

And, their costs for generic drugs for blood pressure, cholesterol, or pre-diabetes management are up $22, $11, and $10, respectively.  If anyone in this county uses Lipitor instead of the generic Atorvastatin, they pay the full cash price. The brand drug is not covered under any insurance plan. That’s $277 per month for Lipitor vs. $1.00 for the generic.  Yes, it is that different!

Harrodsburg, Mercer County, Kentucky

Looking at one of my favorite parts of the country, I wanted to see what was going on in the Bluegrass region.  Like upstate NY, the number of drug plans has decreased. There are now 23 plans versus 30 last year.  And, their premiums are a little lower at $6.80 per month for the least expensive premium plan.  The costs of the same drugs as in the NY analysis increased slightly less at $18, $10, and $6.  But, overall, drug prices are up again for 2022.

In this analysis, I also looked at a pharmacy that was out-of-network and one that is “standard” in-network.  Mercer County has 10 pharmacies available to their Medicare folks.  And, many people really prefer walking into their favorite pharmacy.  But that can be a huge mistake in the Medicare game.

If someone uses the out-of-network pharmacy, they will pay $590 for the year for two generic blood pressure medicines.  That includes the $6.80 monthly premium to be in the plan.  What happens if someone love a different pharmacy that is in the “standard” or non-preferred group? They would pay $423 for the year.  That’s a huge savings of $167 per year.  Just by looking into the pharmacies.

But that’s not where this story ends…

It is very important to make sure the pharmacy where you want to pick up your Rx’s is classified as “preferred, in-network.”  Or, in most cases, the mail order option is also preferred.  The cost for those two generics in Mercer Co. came in at $105. For the year. That is $485 dollars less than anyone would suspect.

The cost of not shopping for your Part D plan, even when your drugs didn’t change, can be a 5-fold hit to your wallet.  Or more.  And, it’s all because the various levers that are at work in the health care system can and do change every year.  It’s nothing that you’re doing wrong.  Unless you don’t spend that hour or two to check your Rxs.

Bottom line here is to be prepared to change the insurer you’ve been using this year.  Be flexible to change your pharmacy.  Try the mail order option.  There is absolutely no reason to be brand loyal to an insurance company.  The insurers are a business.  Their goal is to improve their own profitability.  That’s not necessarily a bad thing…unless you’re not paying attention.  The consequence of inaction is paying more for the exact same drugs that are less expensive elsewhere.

Steps to Take Depend Where You Get Your Part D Coverage

So, get ready to hop over to Medicare.gov and get started on your re-shopping before time runs out.  The steps you will take depend on where your prescription drug coverage comes from today:

• You likely have a “stand-alone” Part D plan if you chose Medicare Part A and Part B plus a Medigap. 
• If you selected a Medicare Advantage plan, your prescription coverage should be bundled with your HMO or PPO. 

In every case, your first step is to make sure you have these two accounts set up online:

1. Your “mySocialSecurity” account.  This links the real you to your Social Security number and helps keep your identity more secure.  If you haven’t done this yet, please do so as soon as possible. 
2. Your “MyMedicare” account.  This is only an option once you have your Medicare number.  And, it’s the only way to store your prescription drugs.  Setting up your account makes this annual shopping expedition much faster.  Grab your Medicare card (you need the number and your official enrollment date) to get started.

Next, find your option below and follow the steps to make this annual retirement to-do efficient and painless.  And please contact me if you need help or have questions.

If you have a stand-alone Medicare Part D plan today

1. Use the Medicare “find plans” tool directly from the Medicare.gov homepage
2. Select “Drug Plan (Part D)” in the list of options to shop on
3. Enter your zip code, county, and answer if you get any type of extra help
4. You’ll be able to retrieve your prescriptions with dosage details if you stored them in your MyMedicare account.  Make sure they are still the exact prescription, dosage, frequency, etc. that you take today and will take next year. Make changes as needed.
5. Add any new prescriptions exactly as on the bottle and save the information.
6. Select up to 4 pharmacies plus mail order for comparison cost shopping. 
7. Make sure you sort on “lowest premium and drug costs” (this should be the default) in the right-hand “sort plans by” box.
8. Scroll through the various insurance companies and plans that include your drugs on their coverage list.  Click on “plan details” to see the more complete cost picture.  Each pharmacy you selected will have an arrangement with each insurer and prices will be listed separately.
9. If one or more of your drugs is very expensive, make sure to look through all the plans to find the best situation for you.
10.  If you find a less expensive overall plan for 2022, either enroll online directly with that insurer or call their 800 number to enroll. 

Your new insurance plan will send you a new Part D card and a confirmation later in December.  Your new plan begins January 1^st.

Make sure you contact your physician’s office and pharmacy with your new Part D plan number to ensure any auto-refills stay on track.

If you don’t need to make a change and are keeping your current Part D plan, you are all set.  Just keep paying the monthly premiums.

If you have a Medicare Advantage plan with Part D today

1. Use the Medicare “find plans” tool directly from the Medicare.gov homepage
2. Select “Medicare Advantage Plan” in the list of options to shop on
3. Enter your zip code, county, and answer if you get any type of extra help
4. You’ll be able to retrieve your prescriptions with dosage details if you stored them in your MyMedicare account.  Make sure they are still the exact prescription, dosage, frequency, etc. that you take today and will take next year. Make changes as needed.
5. Add any new prescriptions exactly as on the bottle and save the information.
6. When finished adding drugs, select up to 4 pharmacies plus the mail order option for cost comparison shopping. 
7. Make sure you sort on “lowest premium and drug costs” (this should be the default) in the right-hand “sort plans by” box.
8. Scroll through the various insurance companies and plans that include your drugs on their coverage list.  Click on “plan details” to see the more complete cost picture.  Scroll down below the costs for health care until you find the specific section for drugs. You’ll see detailed costs from each pharmacy.
9. Make sure to note if all your drugs are covered. If not, try another plan. Or, if one or more of your drugs is very expensive, make sure to look through all the plans to find the best situation for you.  There can be wild swings in options.
10.  If your current Medicare Advantage plan still works best for you overall, you’re done.  If you find a less expensive overall plan for 2022, either enroll online directly with that insurer or call their 800 number to enroll. 

The new plan will send you a new Medicare Advantage plan card and a confirmation later in December.  Make sure you contact your physician’s office and pharmacy with your plan number to ensure any auto-refills stay on track.

What if you don’t get drug coverage from Medicare Part D?

You may be getting prescriptions drug coverage through an employer group plan or union plan.  Each year, they must send you a letter confirming you have “creditable” coverage.  If you have not received a letter, call the benefits office.  So long as you have creditable coverage, you are all set for the coming year.

If, however, the group plan is no longer providing creditable coverage, you must choose a Part D plan.  Make sure to find a Medicare Part D plan as soon as possible. You can choose a stand-alone Part D or explore your options for a Medicare Advantage with Part D plan. You only have 2 months to get in a plan before pricing penalties begin.

For those who served in the military and retired with enough years, you likely get your prescription coverage from TRICARE. And, do not need a separate Part D plan.

If you have coverage from the Federal Employee’s Retirement System (FERS), or as a retired state worker, you may already have a creditable drug plan in place.  Just confirm that you are set for next year.  And, if you have questions, call the customer service line.

There’s Nothing Easy about Medicare Part D Plans

Even though there is a lot of noise behind the scenes, the goal of having a Part D plan is to lower your drug costs.  To that end, Part D plans work relatively well.  But, there is nothing easy about trying to navigate a gigantic system.

Just make sure you are getting the best possible costs for your drug coverage.  Every year.  And only between October 15^th and December 7^th.

Here’s wishing you a wonderful holiday season…and lower Part D costs next year!