Prices are going up on Medicare Part D prescription drug plans next year, so enrollees are being advised to shop around as open enrollment begins next week.
"I don't think anybody is going to see their cost go down," says Cheryl Matheis, AARP's senior vice president for health strategy.
Oftentimes people who feel they're getting good service from their current Medicare Part D plan don't shop around at open enrollment time, Matheis said.
"But because the cost for most of these plans will change for this coming year, it's always a good idea to go and evaluate what they have now and compare," she adds.
Open enrollment for Medicare drug plans will run through Dec. 31, and the national average premium for 2010 stand-alone coverage (excluding Medicare Advantage plans) is running about $39 a month – about 11 percent higher than the current year, according to the Kaiser Family Foundation.
Some updates for 2010 noted by Kaiser and the Centers for Medicare and Medicaid Services:
– 60 percent of the stand-alone plans will come with a deductible, and more than half will charge the standard deductible of $310, which is up from the current year's $295.
– 80 percent of stand-alone plans don't offer any coverage in the ever-widening "doughnut hole," or coverage gap, in which enrollees have to pay for all drug expenses on their own. The gap next year kicks in after $2,830 in total drug spending, and catastrophic coverage isn't available until the enrollee has spent $4,550 out of pocket or racked up $6,440 in total drug costs for the year under the standard benefit design.
– About 1.2 million beneficiaries in stand-alone plans face at least a $10 increase in their monthly premium if they don't switch to a less expensive plan.
– There are 46 prescription drug plans available in Illinois (excluding Medicare Advantage options) and the premium prices will range from $21.50 to $64.40, with the average premium statewide running $46.
– $64.50 is the lowest monthly premium for a stand-alone plan in Illinois offering any coverage for generic drugs in the gap.
"This is a really important time of year for Medicare beneficiaries to see if their plan is working for them," advises Anne Gargano, a community organizer for Champaign County Health Care Consumers.
For most seniors, the coverage gap leaves a huge expense to foot alone, she says, "so that's why most people who fall into the doughnut hole don't get out."
Both Health Care Consumers and AARP want to see changes in Medicare Part D that will close the gap and allow the government to negotiate for lower drug prices.
AARP has endorsed the recently passed House health care reform bill that eliminates the coverage gap over time, cuts in half the cost of the name-brand drugs enrollees have to buy in the coverage gap and allows the government to negotiate for prescription drug prices.
And better drug prices for Medicare enrollees wouldn't just benefit seniors, Matheis said. It's likely to have a positive effect on prices for everyone."I think people have gotten comfortable with Part D over the last few years, and it's very popular with our members," Matheis said. "When they hit that point when they suddenly have no more coverage because they're in the gap, it comes as quite a shock to people sometimes. That's why we like people to look at it very carefully."
Gargano says it also pays to check out the state's wrap-around assistance plan for Medicare Part D beneficiaries, Illinois Cares Rx, to see if they qualify. The program is available for adults 65 and older, or people with disabilities age 16 and older, who meet income eligibility guidelines.
A change in the program this year means the benefits will be more generous for some 22,000 Medicare Part D beneficiaries who have been on the more limited Illinois Cares Rx "basic" assistance plan, which helped cover the cost of medications in only 10 disease categories plus HIV/AIDS. Starting next year, all Medicare enrollees qualifying for the assistance program will be bumped up to the higher benefit level that provides coverage for all drugs on their Part D formularies, according to Lisa Voils, acting chief of the state Bureau of Pharmacy Services.
Do remember, Voils says, that Medicare Part D enrollees need to re-enroll in Illinois Cares Rx each year, and while this isn't a hard and fast deadline, keep in mind that Dec. 4 is about the last day anyone can enroll in time to get an application processed without a break in coverage.
Gargano advises seniors to ask for help if they have any questions about coverage options and especially if they're being pressured by telemarketers to sign up for any plan. And don't sign up for any before thoroughly checking out all your costs – not just the premiums but how much out-of-pocket expense you'll have with the deductible and doughnut hole based on the drugs you take, she said.
"My advice is ask for help," Gargano said. "Once you've signed up, you are locked in after Dec. 31 for the whole year."