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 and into Catastrophic Coverage. Once she reaches that payment stage, she will not pay another penny for her drugs for the remainder of the year. That is one benefit of the Inflation Reduction Act. Then, in 2025, her costs will be capped at $2,000.
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.
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 The Inflation Reduction Act also capped insulin, both injectable and via pump, at $35. During Open Enrollment, those who take insulin should confirm that their plan covers their insulin. (Every plan determines which insulins it will cover and the $35 cap applies only to covered insulins.)
Last updated: 02-27-2024