Diabetes Forecast

Saving Money On Medicare

Open enrollment is almost here. Make sure you’re ready

By Carole Fleck , ,

Wavebreakmedia Ltd./Thinkstock

Maybe you’d rather be raking leaves or cleaning out your closets than comparing costs of health care plans. But Medicare’s annual open enrollment season is about to get underway, and shopping around for new health insurance and prescription drug plans for 2017 could save you money.

Even if you’re satisfied with your current plan, it’s wise to review your policy and make sure premiums and coverages won’t cost you more beginning in January. During open enrollment, which begins October 15 and runs through December 7, you can switch between Medicare Advantage and Original Medicare (Parts A and B), select new policies in each of those plans, and choose a new Medicare Part D prescription drug plan.

“Medicare Part D plans can make changes year to year in cost-sharing for drugs and drugs on their formularies,” says Claire Borelli, director of public policy for the American Diabetes Association. “Don’t be surprised in January. It’s a good idea to reexamine your Part D coverage each year to make sure your plan still meets your needs.”

Here’s a brief overview of what Medicare policies cover:

Part A

This covers inpatient hospital care, home health care, and skilled nursing facility care.

Part B

Doctor visits; lab tests; outpatient care; and durable medical equipment such as blood glucose meters, test strips, insulin pumps, and pump supplies, including the insulin used in the pumps, are included under Part B.

Preventive services, such as annual wellness checkups, diabetes screenings, and diabetes self-management education, are also covered. Generally, Medicare doesn’t cover continuous glucose monitors (CGMs). Earlier this year, the U.S. Department of Health and Human Services announced that Medicare will cover diabetes prevention programs in the future for people on Medicare who are at risk for type 2 diabetes.

Part C

Also known as Medicare Advantage, this covers Part A and Part B benefits through a Medicare-approved plan administered by a private insurance company.

There are a variety of plans within Medicare Advantage, each with a host of options. Among the potential advantages: Some plans offer extra coverage for vision, hearing, and dental services, but you may pay more for it. (Medicare generally doesn’t cover dental expenses unless there are special circumstances, such as if you’ve been in an accident or have a disease requiring dental treatment.) Some plans cap out-of-pocket spending.

Most Medicare Advantage plans include prescription drug coverage so you wouldn’t need to purchase a separate Part D plan. But you must do your homework to see if these plans are right for you. 

Part D

This covers oral and injectable diabetes prescription drugs, including vial insulin not used in a pump, syringes, insulin pens and needles, and other prescription medications, such as blood pressure and cholesterol treatments.

Plan coverages vary. You’ll need to know which of your drugs are on each plan’s formulary and the cost you’ll pay out of pocket, including premiums, co-pays, and deductibles. These plans are run by private insurance companies. 

The Costs

Most people don’t pay a monthly premium for Part A, though they are responsible for deductibles and co-pays. The standard monthly premium for Part B in 2016 was $121.80, or higher depending on income. This doesn’t include out-of-pocket costs such as deductibles and the typical 20 percent co-pay for the cost of the covered service.

Most plans will have a so-called “donut hole,” during which you must pay a larger portion of the cost of all medications. You’re in the donut hole in 2016 when you and your plan together have paid $3,310 for covered medications. In the donut hole this year, you pay 45 percent of the cost of brand-name drugs and 58 percent of the cost of generics. (In 2017, your share decreases to 40 percent and 51 percent, respectively.) Once you and your plan pay out $7,062.50 this year, catastrophic coverage kicks in: You pay 5 percent, or $2.95, for generics and $7.40 for brand-name drugs per prescription. Figures for 2017 weren’t available as of late July.

Medicare Advantage plans vary in cost and coverage. Enrollees often pay monthly premiums, co-pays, and deductibles. Check which doctors and hospitals are in network for any plan you’re considering. Start the process at medicare.gov.

Getting Help

Two programs can reduce the cost of Medicare premiums, co-pays, and deductibles—provided you qualify based on income limits. Under Medicare Savings Programs, your state pays Part B premiums and possibly other expenses. If you need low-cost Part D coverage, you can apply for the federal Extra Help program. Contact your State Health Insurance Assistance Program (SHIP) to see if you qualify or to talk with an insurance counselor.

Learn more at shiptacenter.org or contact Medicare at 1-800-633-4227 or medicare.gov.

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