The New York Times - USA (2020-11-15)

8 BUN THE NEW YORK TIMES, SUNDAY, NOVEMBER 15, 2020

Insurance companies flood the airwaves
and mailboxes with advertisements and
brochures.
None of it is working very well. The Kai-
ser study found that 44 percent of enrollees
had never visited the Medicare website,
with another 18 percent reporting that they
did not have access to the internet or had no
one to go online for them. Only half reported
that they had reviewed “Medicare & You.”
Just 28 percent had ever called the Medi-
care help line; the rest had never called or
were not even aware the line exists.

Why Shopping Is Important

If you’re enrolled only in original Medicare
with a Medigap supplemental plan, and
don’t use a drug plan, there’s no need to re-
evaluate your coverage, experts say. But
Part D drug plans should be reviewed annu-
ally. The same applies to Advantage plans,
which often wrap in prescription coverage
and can make changes to their rosters of in-
network health care providers.
“Plans can not only change the monthly
premium but the list of covered drugs,” said
Frederic Riccardi, president of the Medi-
care Rights Center. “And they can change
the rules around your access to drugs, or
impose quantity limits or require prior au-
thorizations.”

Why We Don’t Do It

Complexity is a key issue. Kaiser found that
30 percent of enrollees said the Medicare
program was either “somewhat difficult” or
“very difficult” to understand, and those
percentages were higher among younger
people on Medicare who have disabilities or
are in poor health.
These plans are required to meet federal
requirements for covered benefits, cost
sharing and other features. But drug plans
have tiers with varying co-payments, coin-
surance, and preferred options for brand-
name drugs, generics and pharmacies.
“The amount of information that con-
sumers need to grasp is dizzying, and it
turns them off from doing a search,” Mr. Ric-
cardi said. “They feel paralyzed about mak-
ing a choice, and some just don’t think there
is a more affordable plan out there for
them.”
But that assumption can be very wrong.
In a review of the 10 most heavily enrolled
Part D plans for next year, Avalere Health
found several with average premiums
jumping by double-digit percentages, with
others holding steady or dropping a bit. Kai-
ser calculates that eight out of 10 enrollees
in stand-alone Part D plans will pay higher
premiums next year in their current plans.

Anthony Hodge, a 65-year-old Medicare

Rights Center client who lives in Massape-

qua, N.Y., expects to save about $1,000 next

year by switching Part D plans. Mr. Hodge

has a kidney condition that will require a

transplant, and he uses seven prescription

drugs. The savings stem from differences in

premiums and co-pays, including details

such as pharmacies used and the “tier” on

which each plan places his medications.

“It’s pretty crazy when you review all the

different plans,” he said. “You can really get

bleary-eyed.”

Supporters of the marketplace approach

note that drug plan premiums have gener-

ally remained affordable since the Part D

program was introduced.

“The existence of these markets, regard-

less of how consumers actually operate and

choose, puts substantial downward pres-

sure on the prices offered by the plans, be-

cause any marginal move away from them

to a competitor has a big effect on their prof-

itability,” said James C. Capretta, a resident

fellow at the American Enterprise Institute

who focuses on health care, entitlement

programs and federal budget policy.

“Even if only 5 or 10 percent of consumers

take advantage of the marketplace, it is a

powerful check on plans raising costs,” he

added.

The average monthly premium for Medi-

care stand-alone prescription drug plans

was $38 this year, according to Kaiser, a

slight increase from $37 in 2010. Moreover,

89 percent of Medicare Advantage plans

next year will include prescription drug

coverage, and 54 percent will charge no ad-

ditional premium beyond the Part B (outpa-

tient services) premium.

But focusing solely on premiums misses

the bigger picture of how the Part D pro-

gram affects enrollees, said Dr. Neuman of

Kaiser.

“Insurers understand that consumers

are more likely to compare premiums than

other plan features that can impact their an-

nual drug costs, so they have an incentive to

offer low-premium products,” she said.

Insurers can extract more from enrollees

through deductibles allowed under the Part

D program, which the government will cap

at $445 next year. Most plans (86 percent)

will charge a deductible next year, and 67

percent will charge the full amount, Kaiser

reported.

Is There Another Way?

When creation of the prescription drug ben-

efit was being debated, progressive Medi-

care advocates fought to expand the exist-

ing program to include drug coverage,

funded by a standard premium, similar to

the structure of Part B. The standard Part B

premium this year is $144.60; the only ex-

ceptions to that are high-income enrollees,

who pay special income-related sur-

charges, and very low-income enrollees,

who are eligible for special subsidies to help

them meet Medicare costs.

“Given the enormous Medicare popula-

tion that could be negotiated for, I think

most drugs could be offered through a

standard Medicare plan,” said Judith A.

Stein, executive director of the Center for

Medicare Advocacy.

“Instead, we have this very fragmented

system that assumes very savvy, active

consumers will somehow shop among doz-

ens of plan options to see what drugs are

available and at what cost with all the myri-

ad co-pays and cost-sharing options,” she

added.

Advocates like Ms. Stein also urged con-

trolling program costs by allowing Medi-

care to negotiate drug prices with pharma-

ceutical companies — something the legis-

lation that created Part D forbids.

A model for this approach is the Depart-

ment of Veterans Affairs, which by law can

buy prescription drugs at the same dis-

counted prices available to the Medicaid

program, and negotiates deeper discounts

on its own.

Getting Help With Enrollment

If you’re uncomfortable using the internet

to search for plans, or don’t have internet

access, the State Health Insurance Assist-

ance Programs network is there for you.

These federally funded counseling services

provide free one-on-one assistance in every

state. The Medicare Rights Center offers a

free consumer help line: 800-333-4114.

You can browse plans on the Medicare

Plan Finder, the official government web-

site that posts stand-alone prescription

drug and Medicare Advantage plan offer-

ings. The plan finder now allows users to

sort plans not only by premiums but for to-

tal costs, including premiums, deductibles,

co-pays and coinsurance payments.

When it comes time to enroll, call Medi-

care to sign up at 800-MEDICARE (800-

633-4227) and to ensure that your enroll-

ment has been processed.

LILY PADULA

CONTINUED FROM PAGE 5

Medicare Choices Leave Many Overwhelmed

RETIRING

Eight out of 10 enrollees

in stand-alone Part D

plans could pay higher

premiums next year in

their current plans.

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