Medicare drug plan increases can happen to you. Drug insurance plans — and other plans — can change frequently. This is the season for renewal of many insurance plans, and so it’s a good time to remind you to look at your plan.
I just got renewal materials for my Aetna Part D Medicare drug plan, and I noticed several things that you might think of as under-the-radar or unremarkable — if not downright surreptitious or sneaky:
- The premium is going up by $3.30, from $7.20 to $10.90. That’s an increase of 51 percent.
- The deductible is going up to $505 from $480, an increase of 5.2 percent.
- One standard co-pay is going up, for Drug Tier 1, to $2 from $1.
- One tier of their oh-so-complicated tiering structure for medications has gone from a firm $46 to a 25 percent co-pay. That may not seem like a big change, but if you’re in that tier and your medication has been $400, you will now go from $46 to $100. That’s real money (see below).
See the screenshot below for details of the mailer they sent me. None of these are eye-popping numbers, but for some people, they will really add up. And for Aetna, over the course of the year, and over the millions of enrollees, they will really add up.
Last year’s Part D increase for a California writer
Cheryl Clark, a freelance journalist, noted a similar phenomenon a year ago in an email to me, referring to a piece she wrote about changing drug plans for MedPage Today, citing her California policy. She wrote in her email of a “doubling of deductibles and a significant policy shift, from charging a flat fee for a drug (say $35 for a month’s supply of a generic statin) to 17% of the cost of that drug (around $650 in 2021).”
Tier 3 drugs include “several brands of generic statins such as rosuvastatin and ezetimibe,” Clark wrote in her article.
“Instead of $104 for a 90-day supply of each of those two drugs, the plan will charge 17% of $925, or $157 for one, and 17% of $800-plus, or $136, for the other, according to this reporter’s conversation with a plan supervisor about her own plan. …
“Additionally, a brand of an inhaler that now costs $105 for a 90-day supply will cost 17% of nearly $1,900, or $324.”
Her own premium went up by only $1, she said, but the significant increase in deductible, to $480 from $250 the previous year, would leave a large amount of new money in the insurer’s pockets.
Clark noted that many patients don’t re-assess their plans during open enrollment, and find themselves surprised later.
“More than seven in 10 Medicare beneficiaries didn’t check or compare their health plans in 2018 for changes in drug plan pricing, Medicare Advantage plan costs, or provider networks for 2019 — leaving them vulnerable to surprising price increases and reductions in the array of doctors their plans will cover,” Clark wrote.
“That’s according to a new report from the Kaiser Family Foundation (KFF), which also found that certain demographic groups who might benefit the most from comparison shopping were even less likely to check for changes in their plans.”
She noted that patients who are surprised by price increases on medications might decide they can’t afford an existing medication and fail to tell their doctors — thereby running the very real risk that an existing condition could become worse.
Re-assess your insurance every year
Every year, it’s wise to re-assess your insurance coverage, be it Medicare, Medicare Part D drug coverage, private insurance, employer-sponsored insurance or anything else.
The Kaiser report said that “in 2021, the average Medicare beneficiaries can choose among 33 Medicare Advantage plans and 30 Part D stand-alone prescription drug plans (PDPs).” That’s a lot of numbers to crunch.
Separate from Medicare, here’s how an acquaintance who had been used to having three family members on the same family plan saved a lot of money by assessing their coverage and deciding to put all three family members on separate insurance plans. He never would have gone this way without analyzing the money — and they saved a ton. Maybe you can too.
Jeanne Pinder is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded ClearHealthCosts.
She was previously a fellow at the Tow Center for Digital Journalism at the Columbia University School of Journalism. ClearHealthCosts has won grants from the Tow-Knight Center for Entrepreneurial Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York; the International Women’s Media Foundation; the John S. and James L. Knight Foundation with KQED public radio in San Francisco and KPCC in Los Angeles; the Lenfest Foundation in Philadelphia for a partnership with The Philadelphia Inquirer; and the New York State Health Foundation for a partnership with WNYC public radio/Gothamist in New York; and other honors.
Her TED talk about fixing health costs has surpassed 2 million views.