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Help! My Medicare Advantage plan costs have skyrocketed.

Here is a question a friend recently asked. 

How can I get out of my Medicare Advantage plan? The costs have skyrocketed and I am very angry about this. 

After a bit more discussion, we learned that our friend is not happy with her plan because the drug prices have skyrocketed. She was paying $47 a month for her prefilled insulin pen and now she pays $152. Her blood pressure medication went from $2.00 to $43.40. And she saw similar increases in her five other medications.  

Our friend’s anger is directed at the wrong source. The Medicare Advantage plan with prescription drug coverage (MA-PD) is not responsible for these increases. Turns out she hit the Coverage Gap, also known as the donut hole. She is responsible for the entire cost of medications during this payment stage of a prescription drug plan. There is a 25% discount on medications but the costs for some drugs can increase greatly. This can happen to anyone with prescription drug coverage. 

Our friend cannot consider changing plans until the Open Enrollment Period (October 15-December 7). Even if she could change plans, it might not make much difference. Every Part D prescription drug plan has the same structure. Once she hits the donut hole, costs go up. The one bit of good news: Because she takes five brand-name medications, she is one of the few who will get out of the donut hole before year’s end. For the month of December, her prefilled insulin pen will cost $21.60, with similar price reductions for all her medications. 

There’s one important thing our friend (and everyone with a drug plan) needs to do during the Open Enrollment Period. Check the costs of medications through every payment stage. The Medicare Plan Finder at medicare.gov can help with this. Looking at the results, she could have saved $110 a month during the Coverage Gap if she had picked another plan.

Besides the fall Open Enrollment Period, there is another opportunity for those who have a Medicare Advantage plan to change coverage. During the Medicare Advantage Open Enrollment Period, January 1-March 31, an individual can switch to a different Advantage plan with or without drug coverage or drop the coverage and return to Original Medicare with a Part D drug plan. 

PS Those who take insulin should also check for plans that participate in the Senior Savings Model. Plans can choose to offer insulin for a maximum copayment of no more than $35.  

Last updated: 02-10-2021