Because my 80 year old mother has traditional (original) Medicare, once a year I evaluate her stand-alone Medicare Prescription Drug (Part D) Plan options during the “open” enrollment window (October 15 – December 7, 2015). I am cutting it short this year because I got kind of busy with other life events. Mom is not capable of “shopping” for the “best” value on her own and without me she would never change plans to save money. My mother is still sharp as a tack, but “shopping” for the “best” value in private health insurance products today requires extensive knowledge of:
- insurance product terminology
- keeping up with the annual “surprises” that can potentially impact the pocketbook
- use of the internet
Twenty years from now, I hope there is someone around to help me when I find myself in the same boat as mom does today.
Let’s begin the process. My first stop is the federal government’s Medicare Part D website where I scroll down to the bottom of the page and click on find health & drug plans. I always pick the Personalized Search option because it takes your personal drug list (which you input and save for next year’s open-enrollment period) and matches it to the lowest cost plans available for you. Part D insurance products are designed around prescription drug formularies (lists of drugs covered with up to four tiered cost-share categories) and the private insurance companies market these products for maximum profit generation.
After we input my mom’s Medicare identification information (Step 1), I proceed to the screen where I can input all of my mom’s current drugs. I check her saved drug list from the year before and up-date the information as needed.
Step 2. Inputting Mom’s Drugs
The next window has me inputting mom’s retail pharmacies where she buys her drugs (Step 3). If you can be flexible (and have several pharmacies nearby), changing pharmacies after you have selected a specific plan can save you money. Some insurance plans negotiate with specific pharmacies for lower costs to them and hopefully for you too.
After continuing to Step 4 (Refine your Plan results) you will see the following:
Since I am only interested in the stand-alone Part D plans, not Medicare Health Plans with drug coverage or Medicare Health Plans without drug coverage (both are Medicare Advantage plans), I select the first choice and Continue to Plan Results.
You are now presented with your plan choices, sorted by one of eight criteria.
Medicare Part D Sort Results By Criteria
I have chosen the Lowest Estimated Annual Retail Drug Costs option for sorting. In the past, I found that using mail order was the cheapest route for getting my mom’s drugs, but that was not the case last year as retail pharmacies have cut more deals with insurance companies. My mom uses both mail order and retail pharmacies for her drug purchases. I would strongly recommend that you sort by more than one criterion. The best plan for your particular situation (drug list, location, financial considerations) should pop-up at the top of multiple lists.
After I am done, Medicare provides us with a summary of mom’s present Part D plan as well as a list of her alternate choices. For my mom’s location, she is presented with 25 options. The first three choices for my mom are shown below.
For comparison, Medicare gives me the pricing information for my mom’s current plan—Cigna-HealthSpring Rx Secure-Xtra. It is important to note that this plan, while very similarly named to Cigna-HealthSpring Rx Secure d(the number 2 choice in my search), is in fact a DIFFERENT insurance plan from the SAME company. Every word (and number) in the titles must be scrutinized very carefully.
The 2016 pricing information for this plan is given below:
I clicked on the enroll button located to the right in the SilverScript Choice summary section, filled in the application details, and ten minutes later received my email confirmation. Because this is my sixth year (or more, I can’t remember when I first started helping mom in this process), the whole process from start to finish took me less than one hour.
My mom is on a very limited income and a $267 savings for the year is a lot of money to her. While my mom is eligible for the Low Income Subsidy (LIS) based on yearly income, she hasn’t depleted her assets to the threshold ($13,640 ) yet. She must bear the total cost of her monthly premiums, annual deductible, copays and coinsurance herself. Helping her save money on her Medicare Part D insurance plan is an unsung Christmas gift I give to my mom every year because I love her dearly. This gift helps her continue to live independently and took me much less time to obtain than any of the tangible Christmas gifts I give her.
For most people, especially if this is your first time changing Medicare Part D plans, the process will be more involved. My mom’s prescription drug needs are relatively simple (six generic prescription drugs of relatively low cost) and her health has been very stable to date. While I feel very good after going through this process of “shopping” for the best deal, I understand that at the age of 80, my mom’s health can change anytime in the future. While I cannot plan for any increased drug needs nor choose the “best” value plan for unforeseen future health problems, I know that next year I will have the opportunity to change again.
If I wasn’t around to help choose the most economical plan every year, my mom would have simply let the plan roll over each year. For her 2015 plan, the insurance company increased the monthly premium 39% (from $32.40 in 2015 to $44.90 in 2016). I would guess that insurance company plan design/pricing strategies are calculated with sophisticated algorithms for maximum profit generation. The fact that most people do not switch from year to year is a fact they exploit very successfully. Even seniors who are capable of going through the process I outlined above may not change in years when sickness takes all their time and energy.
The Bottom Line
It is important to evaluate your current Medicare health coverage during the annual “open” enrollment period for “best” value. I have outlined how easy the process is for Medicare Part D plans above. If you have family members who are less capable of understanding the intricacies of health insurance choices, please lend a hand. I saved my mom $267 and you can likely save even more. Give this valuable gift to moms, dads, grandparents, and even elderly friends. This process requires knowledge of ever changing insurance terminology and marketing tactics as well as internet-savviness to apply.
Individual Americans are at a great disadvantage when buying sophisticated insurance company products fine tuned for maximum profit generation. The insurance companies are getting rich because we lack the time, knowledge, desire, or even energy to extract the best “value” out of the health insurance products we are offered annually. Our inaction only hurts us.