I know there’s been a lot of Medicare information the last 6 weeks. Because of the importance of taking advantage of this window of opportunity, I thought it would be important to again prompt you to review your current Medicare options. THIS IS WORTH REPEATING!
As we all know the cost of cancer is unbelievably expensive with the cost of your medications leading the cost race. If you are relying on your Medicare plan to step up to the plate and give you the coverage you require without reviewing insurer changes each year, then you are missing the boat and probably setting yourself up for a lot of hurt!
Every year Insurers review the cost of medications identifying where they can make the most money and where to pass on savings and cost. Yes, the insured are the beneficiaries of the changes, good or bad. So even though last year your coverage was good don’t expect that same coverage to be there year after year. Medicines can float from one tier to the other perhaps making your out-of-pocket cost higher.
As you make decisions regarding your Medicare plan it is important to understand: drug plans, the differences between each Medicare plan, and drug tiers.
Because of the cost difference and changes insurers can make in their plans, reviewing is ALWAYS your best option. Remember once the enrollment period ends, you're now stuck with the plan you chose or defaulted into (if Medicare-enrolled you in a plan automatically if one closed mid-year).
During this enrollment period, Medicare beneficiaries with basic Medicare Parts A and B can add or switch standalone Part D prescription plans or enroll in an Advantage plan (Part C), which can include prescription coverage. Or you can switch to another Advantage Plan or drop Advantage and go to just Medicare Part A and B. Always consider your current out-of-pocket as well as any pending or possible changes to your treatment plan before making any decisions.
It's also important to be aware that you may have been enrolled in a plan because other plans have consolidated, or you may have been transferred into a more costly plan or one that does not give you the coverage you need. It is important to review this carefully.
Additional new Medicare changes
Remember drug tiers? Tier one is generally the least expensive and tier five the most expensive. Also, if a new drug in your treatment plan has come online in the last year, you really want to check and see what tier it was assigned. Some insurers may move drugs from one tier to another, which can affect your cost. Some plans may drop a medication altogether. It's also important to check the pharmacies that are included in your plan. When pharmacies are designated as “preferred” it means your medications will be less expensive there than at a “standard” pharmacy.
Don’t forget the drug-discount cards. It is possible to find that your prescription may be cheaper if applying for the card rather than covering through your insurance. You will need to request the medication be run through the card first before running it through your insurance. The downside to this is that your plan will not count the medicine’s cost and your co-pay toward your deductible or other calculations it uses to determine your cost share. To make sure you are getting the best drug coverage for your needs, use the online Medicare plan finder at medicare.gov. You can enter the medications you take and the dosage, and the plan finder will rank all of your options.
Here are some points to be aware of. Consider your specific situation. Medicare beneficiaries that have low incomes and or assets may qualify for help paying premiums and other cost-sharing through Medicare’s low-income subsidy program. However, those Medicare beneficiaries with high incomes pay a monthly surcharge for Part D and Part B coverage. These current surcharges for Part D will affect single taxpayers with incomes above $88,000, and for couples, it’s $176,000. (Final costs for 2022 have not yet been determined)
Don’t be complacent and blow off the opportunity to review your Medicare options. You could be saving yourself some money and a lot of headaches.
Diahanna is the lead Financial Coach with the Myeloma Coach program. She and her team of Financial Coaches on the Myeloma Coach team help individuals navigate the financial impact and burden of myeloma. Myeloma Coaches have experience with insurance issues, Medicaid, Medicare, short/long term disability, or financial assistance. All Myeloma Coaches are myeloma patients or caregivers who have personal experience living with myeloma. They can share their personal experience as well as resources that have helped them.
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about the author
Diahanna is the Financial Program Manager for the HealthTree Foundation. She specializes in providing financial help, resources and education for multiple myeloma patients. As a professional financial consultant and former caregiver of her husband who was diagnosed with multiple myeloma, Diahanna perfectly understands the financial issues facing myeloma patients.