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Big hikes in drug prices make Medicare open enrollment shopping a must

Editor’s Note: Journalist Philip Moeller, who writes widely on health and retirement, is here to provide the Medicare answers you need in “Ask Phil, the Medicare Maven.” Send your questions to Phil.

The Ask Phil mailbox has been overflowing with questions since I took a break from answering your queries three weeks ago to focus on Medicare’s annual open enrollment season, which began Oct. 15 and runs through Dec. 7. I’m not surprised that many of these questions dealt with open enrollment. On the very slim chance that this series did not address absolutely every reader’s question with total accuracy and clarity, please let me know.

I also received loads of questions about the feared 52 percent rise in Part B premiums next year. Fortunately, this worst-case scenario will not come to pass. Uncle Sam agreed in the debt ceiling law signed late last week by President Obama to float Medicare a $7.5 billion loan. This will allow the agency to limit the damage to a 15 percent increase. That’s still very steep, but not disastrous. Here are the details, as explained in last week’s Ask Phil.

And now, to your questions.

Mike: My wife’s drug premium increased for 2016 from $29.50/mo. to $62.90/mo. or 113 percent more. Her annual deductible increased from $0 to $250 or 250 percent more. Please explain why.

Phil Moeller: Rising drug prices have led many Medicare drug plans to raise premiums, deductibles and other costs by large amounts. They are free to do this. And you are free to take your business elsewhere. This situation is why open enrollment can be such a powerful way to help you and send a message to insurers who are no longer giving you your best deal.

If you haven’t done so already, go to Medicare’s Plan Finder site, enter your ZIP code and your wife’s prescription needs. Then shop for a cheaper plan. As I’ve explained, you need to make sure a new plan includes the drugs your wife needs and that it includes convenient participating pharmacies.

Anna: My doctor does not accept Medicare. Can I see him as a private care patient, pay him the entire bill and just leave Medicare out of the picture?

Phil Moeller: Your question is so interesting. Many readers have asked similar ones that reflect concern over how much Medicare can control their health care decisions. While Medicare is mandatory, in practical if not always legal terms, there is nothing that prevents you from seeing a doctor who does not participate in Medicare and paying his full fee.

However, there could be some complications should you need more than just an office visit.

For example, there is a new Medicare rule taking effect next year that says Medicare Part D drug plans won’t cover prescriptions written by health care professionals who don’t participate in Medicare.

Also, if your doctor ever needs to provide care for you in a hospital or other in-patient setting, any fees he charges you would not be covered by Medicare.

So, by all means, go ahead if you wish. But be aware of these potential downsides and develop contingency plans as needed.

P. Moeller: I now take five cheap generic drugs that most plans cover and for which I could pay a low premium. I can sign up for a drug plan with only a $12 premium, higher copays and an estimated annual drug cost for my medications of only $590. That’s about half of the same company’s “Plus” plan, which has a monthly premium of $66, lower copays and an annual drug cost of more than $1,000 for me. But what if next March or September I am diagnosed with something that requires top-tier pricey drugs? How does one address that possibility when choosing a plan? Am I missing something obvious? Or is this truly a hidden factor that people only learn about if it occurs?

Phil Moeller: Anyone named P. Moeller [no relation that I know of] goes to the head of the line when I answer questions!

Of course, there is no way for you to know how different insurance plans would charge you for drugs you don’t even know if you’ll need. So the best you can do is general research on how Part D plans cover you in what’s called the donut hole.

All Medicare drug plans have catastrophic protection. It doesn’t totally cap your exposure, but after you’ve spent $4,850 on covered drugs in 2016, you’re on the hook only for small amounts or 5 percent of the cost per prescription, whichever is greater.

Realistically, I’d go with a low-premium plan and comfort myself with the knowledge that it still provides catastrophic coverage. If your drug spending changes enough, you can pick a new plan in 2017 during next year’s open enrollment season.

Ted: When I first signed up for Medicare several years ago, I received free counseling from an expert who recommended a supplementary medical insurance [Medigap] plan. That person is no longer available for consultation, and my premiums are going up exponentially every year! I’m wondering if you could recommend someone in my area with whom I could speak directly about my situation and who might be able to recommend a better alternative?

Phil Moeller: Gee. With those premium increases, I wouldn’t lament that your “consultant” is no longer available!

Seriously, I’m sorry about your escalating premiums. Unfortunately, I have made it a rule never to recommend consultants or financial advisers. It is just not something I feel comfortable doing as a journalist. Maybe no one believes we really are objective and impartial, but I sure try to be!


Which Medigap plan should you get?

There are three different underwriting standards for Medigap policies, which I recently explained in a piece I did for Money Magazine. It sounds like you need to get a new policy that charges premiums that will not increase so much. Unfortunately, this is easier said than done, as the piece explains.

Another possibility is to switch from Original Medicare to a Medicare Advantage plan. These plans have caps on your health spending, so you wouldn’t require a Medigap policy. On the downside, they usually require you to use their network of doctors and hospitals. You’d need to call your important doctors and make sure they’re in the network of whatever plan you like. Last week’s Ask Phil column was about shopping for Medicare Advantage plans. Maybe it will be of some help.

Arthur: At age 71, I have only Medicare Parts A & B. During open enrollment, I wish to add Part D or perhaps switch to a Medicare Advantage plan that includes Part D coverage. One question that I hope that you might address is whether we could transfer our Medicare Advantage plan to a different geographic area should we move in the future?

Phil Moeller: If you move out of the area, you cannot continue using the Medicare Advantage policy where you now live. However, the act of moving will qualify you for a special enrollment period to find a comparable Medicare Advantage plan offered in your new hometown. If there is not a plan that meets your needs, you’d then be able to leave Medicare Advantage and go back to Original Medicare.

Correction: An earlier Ask Phil column included misleading advice to Linda in Seattle. It referred to the existence of Part D drug plans with zero premiums. There are zero premium Medicare Advantage plans that include drug coverage (known as MA-PD plans). But I’ve not been able to find any stand-alone zero premium Part D plans. Part D expenses may be waived for some low-income beneficiaries, but that was not Linda’s situation. The Maven has agreed to read six of his really long past columns aloud as penance.