September 2018 Healthcare Forum: Reducing Your Medical Costs

affordable healthcare, reduce your medical costs, choose the right health insurance, save on medications cost

Woody Allen was asked a few years ago how he felt about growing older and dying someday. He replied, “That’s been done already by others,” implying it’s an old joke. Then he was asked if he wanted to become immortal by having a street in Manhattan named for him after he dies. He said, “I’d rather be immortal by not dying!”

Using humor and denial about the finitude of life are adaptive ways of dealing with the inevitability of death. But putting off and denying the possibility of age-related illnesses along life’s journey and not informing your loved ones about how you want to be treated can jeopardize your access to high-quality medical care, and cause you and your family financial hardship. Not planning can also leave your family in a quandary about how you want to be treated or not, should you become terminally ill.

When most Americans reach age 65, they are entitled to Medicare insurance and can choose from different Medicare Part D plans. You can also receive drug coverage if you decide on a Medicare Advantage Plan (Part C). You can read about Medicare enrollment at: https://www.medicare.gov/people-like-me/new-to-medicare/getting-started-with-medicare.html.

How to Reduce Your Cost for Medications

Which brings us to this month’s topic: How to reduce your cost for medications if you have, or are about to begin, Medicare insurance – in particular, Medicare Part D (drug coverage.) This is especially important for elderly people living on a fixed income, such as Social Security, perhaps with a small pension from an employer. Unfortunately, retired Americans living on limited income often have to choose between buying food and life-saving medications. The good news about Medicare Part D is that when you reach the infamous donut hole (when you’re expected to pay more out-of-pocket for your medications,) the costs have shrunk somewhat thanks to the Affordable Care Act (Obamacare.) The bad news is that the cost of brand name medications is projected to increase about 6% per year (much more than your social security cost of living increases.) Please visit https://www.medicareresources.org/glossary/donut-hole for detailed information about drug costs before and after entering the donut hole.

When to sign up for Medicare Part D

In selecting a Prescription Part D plan, it is wise to select a plan when it is first offered unless you have another credible medication plan administered by an insurance company approved by Medicare, because there is a penalty for late enrollment, and you will have a gap in coverage. The penalty is based on the number of months that have passed when you are first eligible for Medicare or a Medicare Advantage Plan and did not have another credible medication plan in place. The more months you put off selecting a Part D plan, the higher your monthly premium will be when you finally select a Part D plan. The penalty for late enrollment can be avoided if you:

  1. Join a Medicare or Medicare Advantage Drug Plan when first eligible; or
  2. Do not go a consecutive 63 days or longer without a Part D plan or other credible drug plan; or
  3. Inform Medicare about your other drug coverage.

You can sign up for all parts of Medicare three months before turning 65, the month you turn 65 and the following three months. So, you have a total of 7 months to sign up.

Selecting a Medicare Part D Plan

To save money, let’s say you have just turned 65 and are healthy, taking only one or two medications. You may want to select the least expensive Part D plan, making certain the prescription medications you are taking are covered by the plan you select.

Keep in mind that every January, different Part D plans add and delete certain drugs from their formulary, and the cost of certain drugs, especially new brand name medications, can increase dramatically. As you grow older (which most of us believe is better than the alternative) the number and types of medications you take may change, but the plan you initially selected may not be the most cost efficient. So, every October, make a detailed list of the medications and doses you take. Then call the customer service department of the medication plan you have and ask if your drugs are still going to be covered starting in January and if the cost will be increasing substantially. Find out if the monthly premium will change. You may want to compare your current plan with other plans available in your area. If you want to check other insurers that offer prescription plans where you live, you will need to contact companies like Blue Cross Blue Shield, Aetna, etc., or contact an independent insurance agent. If you do select another medication plan, make certain the insurer informs Medicare. If you don’t make any changes in your Medicare insurance, Medicare automatically continues your same plan year after year.

Since we all tend to continue year after year with the same Medicare plan, we suggest you thoroughly review your insurance plan every few years or more frequently, especially if your overall health and medications have changed.

All the Medicare plans and plans from other insurers may seem to get more complex. Your reasoning abilities can likewise change as you get older, for better or worse. So, seek the advice of a knowledgeable family member involved in the healthcare system, an independent insurance agent, your doctors’ experienced office manager, or the director of social services at your local hospital or medical clinic.

As one of our wise professors once said, “With knowledge, there is power.”

Next month (October) will be the third in this four-part series when we explain Medicare Parts A, B, and C, and other types of insurance for those of us in our 60s and older. Adult children of aging parents can also benefit from understanding the “ins and outs” of Medicare so they can be more helpful in advising their parents.

Please send us questions about this month’s forum or other problems you are grappling with regarding securing quality healthcare from our complex system. Answers to some questions will be posted next month. We’ll respond personally to other questions if you provide us with your email address.

Post questions/comments below and follow and like us on Facebook at: www.facebook.com/QualityAffordableHealthcare. We cannot answer questions about your personal medical issues because of medical/legal restrictions and because they are best addressed by your doctor.

If you have family members or friends you think may benefit from our monthly medical forum, please forward this one on to them. If they would like to receive our forum, they can sign up for our mailing list below.

Please watch for updates about our forthcoming book: “Doctor’s Inside Guide to Quality Affordable Healthcare.”

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