How to Choose the Best Medicare Plan for You?

October 15th was the start of Medicare’s Annual Open Enrollment Period that runs through December 7th. During this time, Medicare subscribers can make changes from their current plan.

Changes can include joining or changing:

  • a Medicare Advantage (MA) plan;
  • a Medicare Supplemental (Medigap) plan;
  • a Prescription Drug Plan (PDP) or
  • returning to original Medicare coverage.

Background

Original Medicare is the government run health plan for seniors and disabled people that utilizes private doctors, hospitals and other service providers.

By comparison, Medicare Advantage plans, Prescription Drug plans and Medicare Supplemental plans are all run by private insurance companies. These including a variety of for-profits (eg. UnitedHealthcare, Humana, Aetna), national non-profit organizations such as Blue Cross and many regional non-profit insurers.

In addition, some individuals maybe eligible to receive their health insurance, as a retiree or spouse, through their former employer. Service veteran may be eligible for health care and/or medications from the federal department of Veteran Affairs. And, many people may be eligible for federal, state or county financial assistance with the cost of their Medicare insurance, medical services and medications.

The Importance of Having a Good Medicare Plan

Selecting the best plan for you or your family member is a very important responsibility since the consequences can be significant both to your pocketbook and your ability to receive needed health care from your preferred providers.

However, the vast majority of people seldom make any changes in their insurance unless a crisis occurs. Your decision to stay or change your insurance plan in the Fall, generally results in a year long commitment, with few exceptions.

The Importance of Objective, Comparative Plan Information

Consumer Reports provides over 7 million subscribers with independent, comparative information and ratings of thousands of products and services. This information has proven to be highly valued by prospective buyers for over 70 years.

Health insurance is a billion dollar, a very large and profitable private industry with millions of dollars spent on marketing and sales. Understanding the complexities of different health insurance options and eligibility for financial assistance is a very challenging task. People should look for assistance early from knowledgeable family and friends, non-profit agencies and professionals with objective expertise in this field.

Keep in mind, the advertisements, written literature and presentations that you receive from insurance companies and agents are aimed at selling you their policies for a commission. They are not assessing your medical needs, priorities, budget, comfort with risk and then sharing with you, all of your options.

An insurance broker, who represents multiple companies, may provide you with broader options but is still making their living by selling the plans they represent, not providing you with objective, comparative information to help you make an informed decision.

How to Avoid Problems and Select the Best Plan for You.

  1. Invest time to become aware of the services your buying, what is excluded and your full costs as you would for any major purchase or commitment.
  2. Define your current medical needs
  3. Identify any upcoming or potential for major tests, surgeries or intensive treatment
  4. Prioritize your preferences – what is most important to you?
  5. List your preferred service providers ( eg.doctors, hospitals, pharmacies)
  6. List out your generic and brand-name medications and their costs.
  7. Define your travel plans for the next year.
  8. Define what you can afford to pay for your insurance and health care.
  9. Compare your Medicare plan options and their advantages, disadvantages and cost:
  • Original Medicare,
  • Medicare Advantage plans,
  • Supplemental (Medigap) plans
  • Employer plan (if available)
  1. What to look for in plans
  • Do your preferred providers have contracts with the plan(s) that you’re considering?
  • What is the extent of out-of-network coverage?
  • What is the cost difference between in and out-of-network services?
  • Are all of your medications and preferred pharmacy covered and at what cost?
  • What are the plan’s premiums, deductibles, co-pays and co-Insurance rates?
  • What is annual Maximum Out-of- Pocket limit of your health care expenses?

Resources to Help You Evaluate Various Medicare Advantage and Prescription Drug Plans

  • Medicare.gov – 800-633-4227, is an excellent resource with general information and specific help in evaluating the differences among Medicare Advantage and Prescription Drug Plans (which are used with original Medicare and Medigap plans). If you are not comfortable using a computer, ask for help from a family member, friend or social agency.
  • State Health Insurance Assistance Program (SHIP) 877-839-2675– Medicare contracts with states, counties and non-profit organizations throughout the country to provide individuals with personalized education, support and assistance. These free services include comparative plan information, information regarding eligibility for financial assistance as well as help with selecting a Medicare plan, enrolling, and resolving problems.

To subscribe to blog for more articles on the political/economic dimensions of Medicare plans and policies and their impact on patients’ access to affordable, effective treatment go to http://healthplanadvisor.org.

Americans Favor Government Action to Lower Prescription Drug Costs

A national poll conducted by Kaiser Health News in August 2015, found that:

  • Over 70% of respondents  believe drug costs are unreasonable.
  • While the vast majority of Americans want lower costs, they differ significantly (based on their political ideology), on how prices should be established.
  • Seventy-six  percent of Republicans believe price changes should occur by the current marketplace competition.
  • By comparison, 57% of Democrat and 43% of Independent respondents support a role for the federal government in reviewing and approving drug prices (similar to what is done in Canada and Europe). Government involvement there has resulted in foreign drug costs being approximately 50% less than in the United States where pharmaceutical companies  establish their own prices.

    There is a consensus among respondents with 94% of Democrats and 84% of Republicans favoring a repeal of the 2003 federal law that prohibits Medicare, (with 55 million subscribers) from negotiating prices directly with drug companies.

Background

Canadian to Foreign Drug Price Ratios

The recent KHN poll is consistent with the growing revolt against the pricing practices of pharmaceutical companies which reached a tipping point when Gilead established the price for Sovaldi, a new drug formulation that is used for the treatment of Hepatitis C, at $1,000 a pill.  Other examples include Vertex’s Kalydeco $300,000 a year price to treat cystic fibrosis and Celgene’s Revlimid price of $150,000 year for the treatment of specific forms of cancer.

Prices for patented-protected drugs for life threatening and disabling diseases such as cancer, heart disease, multiple sclerosis, cystic fibrosis, diabetes, have been rising dramatically over the past decade with no end in sight.

According to Express Scripts, the number of people with prescription drug cost in excess of $100,000 a year in the US, tripled in 2014.

A Call to Action

Various stakeholders including insurance companies, pharmacy management companies, cancer treatment specialists and concerned citizens have begun to mobilize, educate their family, friends and colleagues and communicate their grave concerns and demand action by pharmaceutical companies and federal and state governments.

The Wall Street Journal (7.23.15) has reported that the federal government could save and reduce its deficit by an estimated $16 billion a year if Medicare was not prohibited by Congress from directly negotiate drug prices as they do for Medicaid and the VA. 

If you share these concerns over the astronomically high drug prices that few people can afford and that are bankrupting thousands of individuals and adding to public deficits, two actions you can take are:

1.Read and sign the Change.org Concerned Citizen’s petition protesting the high cost of cancer drugs at: http://chn.ge/1WHY7FD

2. Read and ask your Congressional House member and Senators to co-sponsor and vote for the:

To find out your elected representatives contact info go to: https://www.usa.gov/elected-officials

To subscribe to this blog for more articles on the political and economic dimensions of Medicare plans and policies and their impact on patients’ access to affordable and effective treatment go to http://healthplanadvisor.org.