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Medicare’s Most Wanted List For Open Enrollment Drug Plan Review

Remember the westerns you watched on TV growing up – Gunsmoke, Bonanza, The Rifleman? There was always a Wanted poster on a bulletin board in the lawman’s office. It’s only fitting that there should be a Most Wanted list for Medicare Open Enrollment Mistakes.

From October 15 through December 7, Medicare beneficiaries have an opportunity to review their drug coverage and change plans if they find a better option. According to Kaiser Family Foundation, almost 57% of beneficiaries don’t review their coverage annually; they just stick with the plan they have. And given that beneficiaries will get to choose from 19 to 28 stand-alone drug plans and multiple Medicare Advantage plans with drug coverage, they likely could find more cost-effective options.

Here are eight individuals who would be on my Medicare Most Wanted list for failing to review drug coverage during last year’s Open Enrollment Period. If one of these situations fits you, take action.

Elliot doesn’t take any medications.

He turned 65 seven years ago and picked the cheapest plan, one with a monthly premium of $17. This has increased over the years and, in 2022, it is almost $23.

If Elliott had checked the Medicare Plan Finder, he would have found a $5.50 plan for 2022, a $210 savings.

Kathleen was diagnosed with a new chronic medical condition.

For years, Kathleen has taken medications to treat an arthritic condition and cholesterol. In fall 2021, she was hospitalized. Her physician diagnosed Type 2 diabetes and prescribed two medications; one was relatively costly. Kathleen was overwhelmed trying to handle her situation and never paid attention to her drug plan.

After the new diagnosis, her plan was no longer the best for Kathleen. Another plan for 2022 would have saved her over $1,000.

Brett did not realize that his plan was going to be discontinued.

In 2019, Brett turned 65 and enrolled in the lowest premium plan he could find, $11.20 a month, that included his pharmacy in network. He cruised along until January 2022, when he was shocked to discover he was paying a monthly premium of $68.70. If he had opened his Annual Notice of Changes, he would have seen that his low-cost plan was disappearing, a victim of consolidation. He was enrolled automatically in one with a higher premium.

Brett could have signed up for a plan with a $7 premium, a $740 mistake.

Joanne sticks with the lowest premium plan, no matter what.

She takes only one Tier 2 medication. As with most other things in life, she thought that the lowest cost available to her, $6.90 a month, would save the most. However, she did not realize that the tier of a medication could make a big difference.

A plan comparison would have revealed that a monthly premium, almost double what she was paying, would have saved her $225 this year. Her drug was Tier 1 in that plan.

Charles takes a brand-name drug.

His plan charges a coinsurance of 50% for Tier 4 medications. The retail cost of his drug is $210 so he pays $105 at his favorite pharmacy.

The Medicare Plan Finder lists a plan in his area that charges 42% and, at a different pharmacy, the retail cost is $57. This year, he could have paid about $50, almost $700 in savings. And with a coinsurance, if the price of the drug goes up, so does Charles’ cost sharing. Because drug prices never seem to go down, he could have saved even more by switching plans to the lower coinsurance and retail cost.

Shirley enrolled in a drug plan that’s sponsored by the same insurance company as her supplement.

When Shirley retired at age 70, she chose a Medicare supplement plan from an insurance company she absolutely loves. She picked one of that company’s drug plans with a monthly premium of $58.

Shirly takes three medications. She would have done fine with another company’s plan that has an $11.60 premium, a savings of $555.

Samuel always chooses the same plan as his wife, Irene.

Every year, Irene reviews her drug coverage, but Sam doesn’t. Because they both take one medication, he picks the same plan as she. In 2022, when she enrolled in a plan with a monthly premium of $35, he followed. However, they take two very different drugs – hers is a Tier 4 and his, a Tier 1.

Samuel should have checked plans available to him. He would have found a plan that would work with the lowest premium in his area, $6.60, a $340 mistake.

Janice has had the same plan for three years.

Janice lives in a senior community and her son Thomas lets her manage most of her affairs. However, he was concerned because the cost of one drug went up significantly this year. His mom was happy with this plan, so he didn’t push the point.

Janice’s drug plan had removed that drug from its formulary for 2022 so she was paying full price. Her pharmacist may have told her that, but it likely didn’t register. Janice paid the full cost for this drug, over $500. There were several other plans available to her that would have covered the drug for less than $50, a $450 savings.

There are many more who could be on the Most Wanted List for keeping a plan too long. Every year, Part D drug plans can change many things, including:

  • The monthly premium
  • The drug plan deductible
  • Tiers of medications and cost per tier
  • Drugs in the plan’s formulary (list of covered drugs)
  • Pharmacies in the plan’s network, and
  • The list of plans (dropping or adding plans, changing the names).

Every single one of these changes can cost you money.

Open and study that Annual Notice of Changes you received in late September. If you don’t, you could find yourself on this Most Wanted List, spending more money for the same coverage.

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