Medicare Your Coverage Options

New Medicare rule requires insurers to tell people their out-of-pocket drug costs before they fill a prescription

Written by Diane Archer

Even though health care costs can be sky high, people often have little clue what their copay will be in advance of getting a service or  filling a prescription, which leads many to skip care. Unfortunately, insurers have not been required to let them know in advance what their out-of-pocket costs will be.  A new Medicare rule, effective 2021, will require Medicare Part D insurers to tell people their out-of-pocket drug costs before they fill a prescription.

The new Medicare rule is designed to help ensure that people do not skip needed care because they mistakenly assume it is unaffordable. When they go without care, as they too often do, it can lead to worse health outcomes. Medicare’s new rule should help doctors decide which medications to prescribe, in part based on their affordability for patients.

But, there is compelling reason to question whether the new Medicare rule will work as intended. Studies suggest that giving people more health care information only confuses them more. And, there are so many factors that go into people’s out-of-pocket costs, it is hard to imagine that they will all be taken into consideration.

Implementing the Medicare rule will be challenging. For sure, the rule should help some patients. At the very least, doctors will know if a Part D plan covers a particular drug.

But, will insurers factor deductibles into the cost equation? And, will they tell doctors when patients are better off paying for drugs out of pocket than using insurance? Insurers make money off high copays in these instances. Also, will insurers know when patients have access to coupons providing drug discounts?

Moreover, where you fill a prescription can affect your costs. Can and will insurers steer people toward lower-cost medicines? Most important, will Medicare’s new rule mean people will in fact fill more prescriptions and be better off?

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