With Medicare private plans, be they Medicare Advantage plans or Medicare Part D prescription drug plans, your costs are unpredictable. The corporate health insurers offering these health plans are free to increase your costs at any time. It’s another reason that you cannot meaningfully compare your private Medicare health plan options during the Fall open enrollment period.
Susan Jaffe reports for Kaiser Health News on a woman who picked a Humana drug plan through Medicare’s Plan Finder during the Fall open enrollment period specifically because of the copay for the drug she takes. By January, Humana had increased the copay nearly 400 percent!
Not only can Medicare private plans increase drug copays at the beginning of the year, they can do so again and again and again throughout the course of the year. The copays they list for the start of the following year during the Fall open enrollment period theoretically could be part of a bait and switch.
CMS must approve a Part D drug plan’s drug tiering. But, the Part D plans retain a lot of latitude about what to charge enrollees. Also, enrollees’ drug costs depend upon a range of factors, including the pharmacies they use.
AARP analyzed drug prices in December 2021 and again in January 2022. It found that 75 of the 100 drugs that Medicare Part D spends the most on had had a price increase averaging 5.2 percent in that time. None had a price drop.
Medicare does warn people that prices can change. But, it does not allow people to switch to a new Part D drug plan after January 1 if they have been misled into signing up for a drug plan that charges them more than represented on the Medicare Plan Finder. People must wait until the next Fall open enrollment period, when they can again be misled.
Sometimes, drug manufacturers give discounts to insurers or their pharmacy benefit managers. But, it’s impossible to know how much of those discounts insurers pocket. There’s little information surrounding what they do with them. The discounts tend not to go toward lower drug prices. If anything, they go toward lower premiums.
Not surprisingly, lots of people with Medicare can’t afford their drugs even with Part D coverage. The copays are too high. One recent analysis found that a copay increase of as little as $10.40 led many people to stop taking all their medicines and ultimately to thousands of needless deaths.
Fixed and predictable prescription drug copays are increasingly not the norm. Instead, insurers are charging enrollees a percentage of a drug’s price. And, with prescription drug costs often sky high, the coinsurance can be a lot of money.
Medicare offers some enrollees extra help paying for their drugs through the Extra Help program. But, only people who meet specific income and asset levels qualify.
Here’s more from Just Care:
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