Get Ready For Pricey Changes To Medicare

By on October 14, 2015

drugs4Whether you turn 65 next year or you’ve been on Medicare for a while, Nick Frank wants you to know that it could cost more than you expected.

Frank is a Verona resident who has spent two decades in the insurance industry, largely focused on the senior market. He’s calling 2016 at “double whammy” for people who rely on Medicare. That’s because, for only the third time in 40 years, there will be no cost-of-living adjustment (COLA) to Social Security. In addition, the cost of Medicare Part B will rise sharply for a third of the people on Medicare, from $104.90 a month to $159.30. One more bit of bad news: Prices on most of the top drug plans for seniors will also be rising.

“The bottom line,” says Frank, who is president of Absolute Insurance Management in Lodi, “is that if people don’t speak with a senior health advisor they’re going to be paying a lot more.” One place to start gathering information, he says, is at the Essex County Division of Senior Services, which happens to be located just west of Verona’s Community Center. There’s also good information in “Pathways for Caregivers”, a book available from the United Way of Northern New Jersey, which runs monthly caregiver meetings at the VCC.

Even if you have been on Medicare for a while, it might be smart to have a review of your plan now. The agency has moved a lot of drugs into a tiered pricing structure, which might mean that the generic or brand-name drug that you’ve been using could be much more expensive. Camille Troisi, a Cedar Grove senior, was shocked recently to learn that one of the drugs she needs had jumped from $45 a month to $350. “I told the pharmacy forget it, I can’t pay that,” Troisi said. She called Frank, who helped her qualify for the drug’s patient assistance program. These programs, which are often not widely publicized, can cut the cost of drug to little or nothing for lower-income seniors.

It’s not all bad news. Frank notes that the shift in health care reimbursement means that doctors are now being incentivized to keep seniors healthy and at home. There are also new competitors in the Medicare Advantage plan business, like Cloverhealth, a PPO plan that is using proprietary technology to cut overhead so much that most of its plans have no deductible, no primary care co-pay and customers can see any practice that accepts Medicare anywhere in the U.S. Seniors should also know that if they try one of the new plans and find it doesn’t meet their needs, they can switch back without a penalty. “That’s huge,” says Frank, “that’s peace of mind.”

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The open enrollment period for Medicare Advantage plans and Medicare prescription drug coverage runs from October 15 to December 7. To prepare for applying or a reviewing an existing plan, gather the information about the plan you are on now, the drugs you are taking, the doctors you are seeing and your preferred hospitals. There are many plan options and your senior health advisor or insurance broker will need all these details to make sure that your new plan covers your needs. (Caregivers of senior citizens can do this work on their behalf.)

“You have to know the system and dig deep to find the right plan,” says Frank. “There are a lot of complexities to it.”


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