Today is the first day Medicare beneficiaries can change their Part D Prescription plan. Beware, there are a lot of mine fields out there because their remains instability in the Private prescription market.
When congress authorized the Part D (prescription) plan under the Medicare Modernization Act of 2003, the bill granted a blank check to the health industry regarding drug pricing. The health lobby pushed through language which does not permit any price negotiation with the Federal government as there is with drug pricing for the Veterans Administration program.
This no price negotiation is costing tax payers billions of dollars and putting billions of dollars in the pockets of the drug providers. It makes no sense Congress would pass a bill and not insist that pharmaceutical and insurance carriers must use the economy of scale and power in numbers of Medicare beneficiaries to set their prices. There are more than 50 million Medicare beneficiaries in the United States. Ten thousand (10,000) Americans enroll in Medicare each day and will do so each day during the next twenty years.
Since we can only help ourselves as we go up against the Prescription drug industry, below is information for all Medicare members who are renewing their Prescription plans during the annual election period which starts today and ends December 7th. Changes for 2015 must be made during this time period.
- According to a Kaiser Family Foundation study, only 13% of Medicare Part D beneficiaries review their plans and make changes if necessary. That means 87% of Medicare beneficiaries keep the same plan, and put millions of dollars in the pockets of the insurance industry because plans change every year with increased pricing of drugs, drugs removed from formularies, and drugs moved to higher tiers making them more costly.
All of the above along with premium increases allow the insurance providers to maximize their profits because Medicare beneficiaries are not paying attention and keeping the industry competitive.
- Always look at your existing plan and have a competent person review it. Go to your pharmacy, your Area Agency on Aging, SHICK, or a fee based Medicare Coaching service like the one we offer. But do not automatically renew.
- According to Kev Coleman, an analyst at Health Pocket, here are changes in the 2015 Medicare Part D program:
-The base Part D monthly plan will increase 2.2 percent, to $33.13 from 32.42 in 2014.
-The total number of Part D plans available in 2015 will fall 14 percent to 1,001.
-Part D will cover 1,418 drugs in 2015 or 3 percent less than the average plan is covering in 2014.
-Usage restrictions for certain drugs will increase to 37 percent up from 34 percent in 2014. Patients will have to get prior authorization from the insurer to use 22 percent of the drugs up from 19 percent in 2014.
Summary:
Be aware of formulary changes in your plan. We did a review for a client yesterday, and the insurer dropped a very expensive drug that was covered in 2014, but took it off the formulary for 2015. Catching this one move saved our client more than $5000 by changing plans.
Consult with your pharmacist about the medications you are taking and ask for advice about plans you may consider. A pharmacist friend told me that each plan may have a different wrinkle to it like only allowing a 30 day supply on medications, and then getting your medicine for day 31 causes both the pharmacist and you headaches. Don’t get caught in the 30 day rule.
Be vigilant and protect your own interest because your provider sends out what I call the assumed consent renewal letter saying if you don’t want to change your plan, nothing is required. But, the member has to do their due diligence to search for any changes in the plan which few will do.
I hope these tips will benefit each Medicare beneficiary as you wade through the Medicare Part D mine field.
Larry Weigel
The MEDICARE Coach™
1011 Poyntz Ave
Manhattan, KS 66502
(785) 537-0366
