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Author Topic: How Medicare Part D Has Changed in 10 Years. Good article  (Read 15715 times)

lynnet

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How Medicare Part D Has Changed in 10 Years. Good article
« on: October 10, 2015, 05:51:17 PM »
Compare Part D plans annually to get the best price for your prescription medications.

Retirees gained the option to purchase prescription drug coverage through Medicare Part D in 2006. Since then, 24 million people have enrolled in prescription drug plans, and there have been several important changes to the program, according to a new Kaiser Family Foundation report. Here's howMedicare Part D has changed in 10 years.

Fewer choices. The typical Medicare beneficiary has a choice between 30 prescription drug plans, down from a peak of 56 plan options in 2007. Just three companies enroll half of all participants in Medicare Part D: UnitedHealth, Humana and CVS Health, with UnitedHealth having the highest enrollment for all 10 years of the program, KFF found. The number of unique Part D plans peaked at 1,875 in 2007, but has since declined to 1,001 in 2015, the lowest in the history of the program. Only 315 of these plans have continuously operated for the full 10 years.

Premium increases. The average Part D monthly premium, weighted by enrollment, has increased from $25.93 in 2006 to $37.02 in 2015. Most of the premium growth occurred during the early years of the program, with premiums being relatively stable since 2010. "Rising use of generic drugs, triggered by patent expirations for many popular brand name drugs, has been a major factor in slowing premium growth," according to the report. However, premium costs range from $12.60 to $101.40 for plans providing similar benefits in 2015. "Some older, established plans have raised premiums more rapidly than the national average, while newer plans tend to set premiums low in order to build enrollment, but may raise them rapidly in subsequent years," KFF found. "As a result, beneficiaries who stay in the same plan tend to pay more over time."

Higher deductibles. The standard Part D deductible has increased from $250 in 2006 to $320 in 2015. "The deductible could be as high as $360 in 2016, and that's an important amount that people will have to pay before the plan will start covering any of their prescription drugs," says Juliette Cubanski, a policy analyst at the Kaiser Family Foundation and co-author of the report. Some 45 percent of plans change the standard deductible in 2015, up slightly from 42 percent in 2006. About the same percentage of Part D plans charge no deductible, down from 56 percent in 2006. And 7 percent of plans charge a smaller deductible in 2015.

Plan design changes. Most Part D beneficiaries (80 percent) are in plans that put covered medications into five tiers with different out-of-pocket costs. The median cost-sharing amount is $1 for preferred generics, $4 for nonpreferred generics, $38 for preferred brands and $80 for nonpreferred brands. Drugs in the fifth specialty tier typically have the highest out-of-pocket costs, with half of plans passing along 33 percent of the cost of the medication to retirees, up from 13 percent of plans in 2006. In previous years there was a greater variety of tier structures including many three and four tier plans. Out-of-pocket costs for brand name drugs increased by about 36 percent between 2006 and 2015, while cost-sharing requirements decreased for generic drugs over the same time period.

Smaller coverage gap. Medicare Part D has a coverage gap, which is often called the donut hole. The 2010 Affordable Care Act contained provisions to gradually close the coverage gap, but it won't be completely eliminated until 2020. In 2015, the gap begins when you have spent $2,960 on covered drugs, after which you are responsible for 45 percent of the cost for brand name prescription drugs and 65 percent of the price of generics until catastrophic coverage kicks in. Most plans (74 percent) don't offer any additional gap coverage, and plans that do tend to cost more.

Preferred pharmacies. Most Medicare Part D plans (87 percent) now have preferred pharmacies where retirees can pay lower cost sharing for their medications, up from 7 percent in 2011. Retirees who don't shop at the pharmacies where their plan has negotiated favorable rates will pay higher out-of-pocket costs. "If you have a particular pharmacy that you like to use, then it's important to see whether there is going to be a higher cost if you continue using that pharmacist," says Jack Hoadley, a health policy analyst at Georgetown University and co-author of the report. "If you are a person who is willing to switch pharmacies, maybe you will be able to save money."

grove800

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Re: How Medicare Part D Has Changed in 10 Years. Good article
« Reply #1 on: October 10, 2015, 11:19:28 PM »
I have handled insurance for 35 years plus and for some reason Medicare and Medicare drug plan is so confusing to me.  My husband turned 65 this year and he wanted my help with decisions on which plans.  Very confusing.  Is there an out of pocket max for Medicare part D?  If I was ever approved in my instance I take Spriva and Advair no generic, very pricey months supply of those 2 is close to 1,000.  Does this mean I would pay 45 percent?  I know up yo 2700 then catastrophic kicks in, for some reason I am still not getting this.  Okay 180 of Opana 10 mg is 1600.00 that's  1 month would I be paying the 45 percent till an out of pocket max comes into play.  I know I'm getting ahead of myself since my heating isn't even scheduled but I have 15 scripts per month or more, something to think about.

Right now after my deductible is met I'm  covered at 100 percent.  My plasma alone is 5400.00 per month before discount would that also be 45 percent.

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Helper

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Re: How Medicare Part D Has Changed in 10 Years. Good article
« Reply #2 on: October 11, 2015, 05:37:27 AM »
With Medicare Part D, once you get through the coverage gap, you pay 5% of the cost of medications   (or a minimum of like $2.65 for generic  or $7something for brand).

Mama

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Re: How Medicare Part D Has Changed in 10 Years. Good article
« Reply #3 on: October 11, 2015, 03:04:40 PM »
I have handled insurance for 35 years plus and for some reason Medicare and Medicare drug plan is so confusing to me.  My husband turned 65 this year and he wanted my help with decisions on which plans.  Very confusing.  Is there an out of pocket max for Medicare part D?  If I was ever approved in my instance I take Spriva and Advair no generic, very pricey months supply of those 2 is close to 1,000.  Does this mean I would pay 45 percent?  I know up yo 2700 then catastrophic kicks in, for some reason I am still not getting this.  Okay 180 of Opana 10 mg is 1600.00 that's  1 month would I be paying the 45 percent till an out of pocket max comes into play.  I know I'm getting ahead of myself since my heating isn't even scheduled but I have 15 scripts per month or more, something to think about.

Right now after my deductible is met I'm  covered at 100 percent.  My plasma alone is 5400.00 per month before discount would that also be 45 percent.



You're right, it's very confusing.

My husband just retired and I signed him up for Medicare Part B.  We chose a Medicare Advantage Plan with prescription drug coverage. It's a Humana PPO plan (extra $52/month...$55/month in 2016).  He also takes Spiriva and Advair.  The don't yet make a generic for either but I heard that Advair may soon have a generic since the patent for the medicine already ran out and the patent for the discus (the delivery system) is set to run out next year.  Anyway, I just ordered a 3 month supply through their mail order pharmacy of each and it was about $250 for a 3 month supply.

You can do a personalized search on Medicare.gov.  You put in your zip and then list all of your meds and it will show you which plans you can choose from and how much your meds will cost.
« Last Edit: October 11, 2015, 03:06:36 PM by Mama »

ChugginAlong

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Re: How Medicare Part D Has Changed in 10 Years. Good article
« Reply #4 on: October 11, 2015, 07:26:20 PM »
If you qualify for extra help, costs will be lower.

http://www.ssa.gov/medicare/prescriptionhelp/

It was so confusing to find a plan, and because my coverage started in August, I have to look at all  the 2016 plans now.

lynnet

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Medicare Premium Part B for NEW ELIGIBLES $159.30
« Reply #5 on: October 12, 2015, 06:57:58 AM »
Premiums cannot rise more than the amount a person's Social Security benefits rise due to inflation, says Joseph Stenken, author of 2015 Social Security & Medicare Facts.

But there are exceptions to the "hold harmless" rule.

In order for an individual to be eligible for the 'hold harmless' provisions the person must have been receiving Social Security benefits and also paying Part B premiums for the last two months of the previous year,” says Stenken.

For example, to avoid the increase to Part B premiums in 2016, the person must have been receiving Social Security benefits for November and December 2015 and having Part B premiums subtracted from those benefit payments, says Stenken. “Also, to be eligible for hold harmless, the individual's income must not exceed the threshold for higher Part B premiums,”

The premium for Part B will remain $104.90 for about 70% of all recipients.  The increase in premiums for those that receive extra help will be picked up by the states, not the individual.  New eligibles will pay $159.30.

Some good news--  this is only temporary for those having to absorb this increase (unless you are over the income limits) In future years when we get another COLA increase the costs increase in Part B services will again be reallocated to all us us and the hold harmless clause will be void.  Had everyone on Part B covered the medical care cost increase, CMS reports Part B would have run about $112 for all this year.



 

grove800

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Re: How Medicare Part D Has Changed in 10 Years. Good article
« Reply #6 on: October 13, 2015, 07:46:19 AM »
Thanks all for the info.  Mama that 250.00 I assume was for both so like 125.00 each for 3 months. Correct?  Even tho the patent runs out does not mean genic since zetia is well over due and patent ran out in 2013.  The cost of drugs is mind blowing.  Let me give you another example I was taking Glumetza for diabetis type 11, generally steriod induced its a better of metformin,  I filled in March of 15. 30 pills, $347.00, due to upcoming steriod injections had filled in August for 30 days, since I need to take 10 days before and 10 days after new price 3,547.00.  I called Blue Cross to report a mistake they replied no that's right, I told CVS pharmacy take off my profile, I will never take again.  That's crazy.  Not sure why I went off here but that's insane how does anyone afford multiple medications on fixed monthly amount.  I have not looked into what anyone else posted because like I said I'm not even approved yet and if I am Medicare should be available in Dec of this year and it is so confusing.
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Mama

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Re: How Medicare Part D Has Changed in 10 Years. Good article
« Reply #7 on: October 13, 2015, 02:37:20 PM »
Thanks all for the info.  Mama that 250.00 I assume was for both so like 125.00 each for 3 months. Correct?  Even tho the patent runs out does not mean genic since zetia is well over due and patent ran out in 2013.  The cost of drugs is mind blowing.  Let me give you another example I was taking Glumetza for diabetis type 11, generally steriod induced its a better of metformin,  I filled in March of 15. 30 pills, $347.00, due to upcoming steriod injections had filled in August for 30 days, since I need to take 10 days before and 10 days after new price 3,547.00.  I called Blue Cross to report a mistake they replied no that's right, I told CVS pharmacy take off my profile, I will never take again.  That's crazy.  Not sure why I went off here but that's insane how does anyone afford multiple medications on fixed monthly amount.  I have not looked into what anyone else posted because like I said I'm not even approved yet and if I am Medicare should be available in Dec of this year and it is so confusing.


Yes.  It's $125 each for a 3 month supply.  I don't know what it will be when we reach the so called "donut hole" but that is what it is for now.  I know what you are talking about.  The price of some of these meds are ridiculous.

grove800

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Re: How Medicare Part D Has Changed in 10 Years. Good article
« Reply #8 on: October 16, 2015, 04:28:30 PM »
Thanks Mama
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Artista

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Re: How Medicare Part D Has Changed in 10 Years. Good article
« Reply #9 on: October 18, 2015, 01:12:01 AM »
Feb 2017 is when I qualify for MC. This upsets me.  It's going to cost MORE for the part B which covers only 80% and if you do pt D, it's more $ out. I'm on Obamacare BC PPO and in 2016 will be paying $150 a month for $550 deductible with a $2250 out of pocket max. I am a breast cancer patient and thank God if I had to get bc it's this year and next yr for big costs otherwise I'd be in more financial trouble!

Can you opt NOT to take MC at all, even pt A, and just keep Obamacare?? I'm 51 so if I wasn't disabled, I wouldn't qualify for MC anyway.

How do seniors and low income folks do it?? grrrrrrrrrrrr!

Lit Love

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Re: How Medicare Part D Has Changed in 10 Years. Good article
« Reply #10 on: October 18, 2015, 03:19:12 AM »
Feb 2017 is when I qualify for MC. This upsets me.  It's going to cost MORE for the part B which covers only 80% and if you do pt D, it's more $ out. I'm on Obamacare BC PPO and in 2016 will be paying $150 a month for $550 deductible with a $2250 out of pocket max. I am a breast cancer patient and thank God if I had to get bc it's this year and next yr for big costs otherwise I'd be in more financial trouble!

Can you opt NOT to take MC at all, even pt A, and just keep Obamacare?? I'm 51 so if I wasn't disabled, I wouldn't qualify for MC anyway.

How do seniors and low income folks do it?? grrrrrrrrrrrr!

No, you don't have that option.  You can explore Advantage plans when you become eligible.  Some are free and some have a cost.  They'll cover the 20% and give you drug coverage.  Or you can purchase a Part D plan and a supplement.  Depending on your income, you may qualify for additional assistance.
« Last Edit: October 18, 2015, 03:22:37 AM by Lit Love »

lynnet

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Re: Medicare Premium Part B for NEW ELIGIBLES now $123 not projected $159.30
« Reply #11 on: October 27, 2015, 03:21:03 PM »
Premiums cannot rise more than the amount a person's Social Security benefits rise due to inflation, says Joseph Stenken, author of 2015 Social Security & Medicare Facts.

But there are exceptions to the "hold harmless" rule.

In order for an individual to be eligible for the 'hold harmless' provisions the person must have been receiving Social Security benefits and also paying Part B premiums for the last two months of the previous year,” says Stenken.

For example, to avoid the increase to Part B premiums in 2016, the person must have been receiving Social Security benefits for November and December 2015 and having Part B premiums subtracted from those benefit payments, says Stenken. “Also, to be eligible for hold harmless, the individual's income must not exceed the threshold for higher Part B premiums,”

The premium for Part B will remain $104.90 for about 70% of all recipients.  The increase in premiums for those that receive extra help will be picked up by the states, not the individual.  New eligibles will pay $159.30.

Some good news--  this is only temporary for those having to absorb this increase (unless you are over the income limits) In future years when we get another COLA increase the costs increase in Part B services will again be reallocated to all us us and the hold harmless clause will be void.  Had everyone on Part B covered the medical care cost increase, CMS reports Part B would have run about $112 for all this year.



The tentative budget agreement forged by congressional leaders and the Obama administration will ward off a
historic spike in Medicare premiums for the coming year, but it will nevertheless require nearly one in three older
Americans to pay 17 percent more in monthly premiums for doctors’ visits and other outpatient care.
Under the agreement, Medicare’s Part B premiums for this group of roughly 15 million people will increase from the
current rate of $104.90 per month to $120 per month next year, plus a $3 surcharge.


So new eligibles will pay  $123  not the $159, much better news
« Last Edit: October 27, 2015, 03:26:15 PM by lynnet »

imaginarylion

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Re: How Medicare Part D Has Changed in 10 Years. Good article
« Reply #12 on: October 27, 2015, 05:57:47 PM »
Thanks!

 

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