Aetna, Cigna, and WellCare! Oh my!

If you are nearing or over the age of 65, you’ve probably seen these names in your mailbox (along with the likes of Blue Cross Blue Shield, AARP, and others). This year, the average Medicare beneficiary will have 23 Medicare drug plans (Part D) available to choose from during open enrollment.¹

While assessing the lions, tigers, and bears of Medicare may not be worth the cost of an up-close evaluation (at least in my opinion), an annual review of Medicare Part D plans during open enrollment should be a priority for all Medicare beneficiaries.

Open enrollment began on October 15th and will continue until December 7th. Each year, Medicare beneficiaries should review current prescription drug coverage and other available drug plans to ensure the most cost-effective coverage is in place, especially since this is the only window to elect plan changes for the upcoming year (unless a special enrollment period applies). Changes elected during open enrollment will take effect for the plan year beginning January 1, 2023.

There may be changes to the costs associated with the drug plans (including premiums, deductibles, and drug costs), coverage of certain prescription drugs, and network changes impacting approved doctors or pharmacies. While switching plans may not be necessary, it is still recommended to at least review existing coverage for applicable changes and compare it to other available plans.

Medicare beneficiaries may have heard about coverage changes related to insulin. Effective January 1, 2023, plans can no longer charge more than $35 for a one-month supply of each Medicare Part D-covered insulin². Insulin will also no longer have a deductible.

The $35 per month cap applies for 60- and 90-day supplies. There are similar caps for traditional insulin pumps expected later in 2023. Be aware that this new price cap may not be factored into the estimated plan costs when reviewing 2023 plan options³.

Remember, even if a Medicare beneficiary is not currently taking prescription drugs, there is likely still a need to have a basic plan in place due to lifelong penalties for missing the initial enrollment window (unless a special enrollment period applies).

Part D premiums are also subject to the income-related monthly adjustment amounts, or IRMAA. So if a Medicare beneficiary has a higher income, a higher premium may be associated with the drug plan.

A recent study found that 7 out of 10 Medicare beneficiaries did not compare their plans⁴. This is likely due to the process of filtering through approximately 23 plans, inputting personal prescription drug information, and utilizing an online tool to do so on Medicare.gov.

In the same study, “. . . nearly half (47%) of all beneficiaries with Medicare said they had never visited the official Medicare website for information . . .”

Hopefully, the following tips will ease the process of reviewing Medicare drug plans:

1. Gather a list of current prescription drugs, including the name of the drug, package type, quantity, and frequency. You can also request this information from your pharmacy.
2. Visit the official Medicare website at this link⁵ to review the 2023 prescription drug plans available in your zip code.
3. The most beneficial use of the plan comparison tool is to enter the above list of current prescription drugs and preferred pharmacies, as the results generated will suit the Medicare beneficiary’s personal needs.
4. Adjust necessary filters on the plan comparison tool. For example, Medicare beneficiaries can sort plans by lowest drug + premium cost. This minor adjustment reviews plans based on cost-effectiveness for the plan year versus just filtering by lowest monthly premium or lowest annual deductible.
5. The plan comparison tool also includes star ratings for each plan, which can help evaluate areas of customer service and member experience. This type of information may be helpful in evaluating two plans of similar cost.
6. Seek guidance from a trusted advisor if needed.

The cost savings may not appear substantial initially, but unnecessary overspending on prescription drug coverage is usually not a preferred method for passing on your legacy.

Sources:

1. https://www.kff.org/medicare/issue-brief/medicare-part-d-a-first-look-at-medicare-prescription-drug-plans-in-2022/
2. https://www.medicare.gov/coverage/insulin?utm_source=google&utm_medium=paid_search&utm_campaign=pn-cmsoe-insulin-2022-gm&utm_term=trafficdriving&utm_content=pn-10152022_insulin_rsa1
3. https://www.medicare.gov/coverage/insulin?utm_campaign=20221006_oep_mpf_gsm&utm_content=english&utm_medium=email&utm_source=govdelivery
4. https://www.kff.org/medicare/press-release/7-in-10-medicare-beneficiaries-report-t[…]-their-coverage-options-during-a-recent-open-enrollment-period/
5. https://www.medicare.gov/plan-compare/#/?year=2023&lang=en

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