This is a very challenging time of year for Medicare “beneficiaries” – or, “sufferers” if you want to know the truth. It’s not that I’m not happy with the benefits – I am. But making sure we are in the right prescription drug plans (PDPs) is a challenge beyond belief. And, it can be very expensive – in dollars and/or time – if we don’t choose the right plan.
I’ll cut to the chase here: how are we supposed to know what coverage in the 31 PDPs in our area will cost? The government supposedly tells us on Medicare.gov, in a plan finder tool that’s probably not far off from what the new health insurance exchanges offer. But the information in the finder appears not to be correct.
How do I know? Well ... I’m also shopping through ExtendHealth, which Bloomberg BNA uses to manage health care reimbursement accounts (HRAs) for retirees. We get enough of a stipend each year that, so far anyway, a big chunk of our out-of-pocket costs are reimbursed from the account. So far, so good.
ExtendHealth also is supposed to help us shop for plans when we first sign up for Medicare, and then annually during the open enrollment season. It’s necessary to shop again each year if you have medications that you take on a routine basis. That’s because the plans change each year, as do their formularies (lists of drugs they cover and the coverage level, or tier, that determines how much of the cost you will have to pay). So, you need to be aware of how much the premium has changed year-to-year as well as whether your medications are still on the formulary and in the same tier. The amount of your co-insurance or co-pay also can change from one year to the next. And, if your medications have changed this is your chance to make sure the new ones are covered and your plan will pick up as much as possible of the cost.
Here’s what I found out by shopping on both sites – it appears that the basic information about the plans on Medicare.gov is not always correct. Just taking one plan – the AARP “saver plus” plan – as an example, Medicare.gov says the premium is $22.50 per month. ExtendHealth says the premium is $15 a month. ExtendHealth says the deductible is $325; Medicare.gov says it’s $310. Who am I to believe? Well, ExtendHealth of course – they will pay the premiums directly from my HRA, so if they quote me the wrong price they might have to sell it to me for what they said it would cost.
I wish the complications stopped there, but they don’t. Now we have come to understand that the prices of the drugs are different from one plan to the next and among pharmacies – and even for two plans from one insurer at the same pharmacy. So, we are down to creating a spreadsheet that shows the retail cost at CVS, Walmart, and Safeway (important comparisons if the plan has a deductible, if the drug isn’t on the formulary, or if it’s in a tier with a high co-insurance percentage). A recent inquiry found that annual costs (premiums + deductible + copays/coinsurance) for one plan would be about $700 and for the same drugs at another plan could run almost $3,000. This is crazy!
I’m just scratching the surface here and my brain already hurts from researching to write about it, so I’ll stop. But before I close, I also want to mention another aspect of PDP coverage – mail-order pharmacies. Medicare.gov tells what the drugs will cost at the company’s mail-order branch or contractor – but so far I haven’t found that on ExtendHealth’s site. In most cases I’ve researched, the cost is less for a three-month supply than it would be for the same medication purchased in 30-day supplies at a retail pharmacy. So, I’m writing down the retail pharmacy information from ExtendHealth and then turning to Medicare.gov for the mail-order information – which may be about as accurate as the premium and deductible data available there.
Mail-order is where we got caught when Robert signed up for Medicare last year. ExtendHealth was up front about the fact that the plan with the lowest premium plus drug costs had no mail-order pharmacy. We were concerned, though, that this plan offered a $0 deductible only if the Rx is filled at Walmart or Target – neither of which is convenient for us. One medication he takes is a controlled substance, for which he must get a paper prescription from the doctor each time it’s refilled. That can be a pain if you have to do it every month, so he asked about getting a 90-day supply. The ExtendHealth representative told him he could do that at the retail pharmacies. Not true. So, we’ve trucked off to Walmart once a month to refill his prescriptions. It can’t be called in, so we always have to wait.
This year we wanted to make sure that he has access to a mail-order pharmacy. To find out, and to find out which are each plan’s network pharmacies and preferred pharmacies (where the cost is even less), you have to read the fine print on the ExtendHealth site. Or, you can go to Medicare.gov – if you trust them to be giving you accurate information.
I could make a full-time job blogging about being a health care consumer. I’ve written a lot about health care since retiring from BNA, and unfortunately more than I have wanted to write on this blog as a health care consumer for the last year and a half. As a topic to parse and write about, this is the worst I’ve covered.
Give me taxes any old day!!