Heads-up, seniors. For those on Medicare, this month can be critical.
It’s the official start of a once-a-year window when seniors can switch their Part C (hospital/medical care) and Part D (prescription drug) plans. Those who ignore the open enrollment season, which runs Oct. 15 through Dec. 7, could wind up paying hundreds of dollars in unnecessary prescription drug charges next year, especially as some drug prices have soared in recent months, say Medicare experts.
It’s also a potentially treacherous period, when scammers and predatory insurance agents ramp up their efforts to steal seniors’ Medicare numbers or entice them into costly, inappropriate coverage.
Not everyone needs to switch their Medicare plans, but everyone should at least review their current prescription drug coverage to see if any drastic changes have occurred.
“On the Part D side, the advice always was that if you’re happy with your plan, stick with it. But that’s the wrong advice,” said Dr. Rajul Patel, a University of the Pacific pharmacy school assistant professor who oversees a free series of Medicare prescription drug clinics every fall.
Paying attention to changes is especially critical this year, amid wild swings in some prescription drug costs. Certain drugs for treating cancer and Hepatitis C, for instance, have shot up to $1,000 or more a pill. Last month, Turing Pharmaceuticals was forced to back down when it upped the price of Daraprim, used to treat malaria-related parasites, from $13.50 to a whopping $750 a pill.
But plenty of other far more common prescriptions also are enduring cost increases.
The average retail price of more than 200 brand-name drugs commonly used by older Americans – including those for treating hypertension, diabetes and high cholesterol – jumped nearly 13 percent in 2013, according to an AARP study last November. Calling it the highest annual increase since 2004, AARP said 97 percent of the 227 brand-name drugs saw price increases.
Also seeing unexpected price spikes were some generics, such as pravastatin sodium, a cholesterol medication that soared from $27 to $196 for a one-year supply, or doxycycline hyclate, a commonly used antibiotic that bounced from $20 for 500 capsules to a whopping $1,849 between October 2013 and April 2014. A comparable basket of 280 generic prescription drugs showed a 4 percent decline, AARP said.
“If these price increases continue, we’ll likely see more people – particularly older people, who are often on fixed incomes – stop taking life-saving medications because they simply can’t afford them, leading to higher health care costs down the road,” said Debra Whitman, AARP vice president for policy, in a statement.
The recent spate of prescription drug hikes has drawn congressional scrutiny into possible causes, including higher costs for producing generics, less competition due to pharmaceutical company mergers and possible price gouging.
Each year, many Part D insurers (or Part C plans that include prescription drugs) change their formulary – the list of drugs they cover – or they can radically jump the cost, based on negotiated rates with pharmaceutical companies. Premiums, co-pays and deductibles can also change.
Patel said insurers are required to send seniors an annual letter notifying them of changes to their pharmacy benefits, such as dropping a particular drug or upping the price. But those notices – as thick “as a phone book” – are often overlooked by consumers, Patel said.
Rude shock at pharmacy
In January, when new Medicare plans go into effect, some seniors may be in for a shock when they show up at their local pharmacy to renew a prescription.
“It could be their co-pay was $25 for a medication, but that same drug now costs $300 because it’s no longer covered,” Patel said. “You could be paying hundreds and hundreds for that same drug.”
There are at least 25 different insurance plans offering Part D prescription coverage in California. Seniors can get help at Medicare counseling offices, University of the Pacific clinics or online at Medicare.gov, where there’s a comparison tool that lets you plug in your prescriptions and dosages, then compare plans by costs.
“It’s a hassle, we know that. But everybody on Medicare should review their drug plan annually,” said Margaret Reilly, program manager for HICAP (Health Insurance Counseling & Advocacy Program), the nine-county Medicare counseling program based in West Sacramento. “You only have this one opportunity to change plans or you’re stuck for another year.”
In the past eight years of doing free Medicare drug plan counseling, the UOP School of Pharmacy and Health Services said seniors saved an average of $896 by switching to a lower-priced plan. “They aren’t changing anything they’re taking, just the provider where it came from,” Patel noted.
Another aspect of the university’s clinics is a personalized review of each patient’s medications. Too often, Patel said, the pharmacists find prescribed medications that contradict each other or simply aren’t necessary. In some cases, seniors could be taking medications that contradict each other, putting them at risk of falls or medical complications.
Patel said it’s not a matter of trying to second-guess a doctor’s prescription. “We’re a second set of eyes. A primary care doctor may not realize what a specialist is prescribing,” he said.
Most seniors take an average of six medications, he said. Sometimes two different doctors are prescribing medications from the same pharmacological class. “If you have multiple medications, you’re not likely to derive any added benefit. But the side effects could increase substantially,” he said.
For instance, the pharmacy professor said, it’s not uncommon for seniors to take sleep medications, like Ambien, Lunesta or Restoril. But the so-called “morning hangover effect,” a side effect that leaves some people still groggy in the morning, can be a contributing factor in falls and hip fractures.
Those attending the clinics should bring their Medicare card and a bag of all their regular prescription medications in their original bottles, including over-the-counter medications, so pharmacists can get a complete picture of all their drugs and dosages. (For clinic locations and appointments, see box.)
Beware of fraud
The annual open enrollment season, which runs through Dec. 7, is considered prime hunting season for scammers who target unsuspecting seniors.
“It’s a major vulnerability year-round, but (fraud) does rear its ugly head more prominently during open enrollment,” said Micki Nozaki, project director for the California Senior Medicare Patrol, which is federally funded to help spot and prevent Medicare fraud and abuse.
This time of year, seniors can be duped into giving up their Medicare numbers, enticed by free lunches, prize drawings and other inducements, Nozaki said. Others can be targeted by unscrupulous insurance agents, who want to rack up commissions by getting seniors signed up for new plans that may not allow them to continue seeing their doctors or get needed medications.
Under Medicare rules, insurance agents are prohibited from knocking on doors, making cold calls or sending unsolicited emails, Nozaki said. But it does happen, she said, noting that some insurance agents host booths at health fairs and other senior-related events to hand out business cards, offer prizes or even cash for enrolling in their health plan. Oftentimes, they tell seniors their health plan must be changed each year, which isn’t true.
Although most agents are legitimate, she noted, “Some are hungry for commissions and they go outside the rules.”
In a recent example, Nozaki said, at least 30 senior in Southern California were enticed with a free chartered bus trip to the Morongo Casino Resort & Spa, the tribal casino east of Riverside, and given $20 in gambling money. In return, she said, the insurance agent collected their Medicare card numbers and enrolled them in new Medicare plans that were deemed inappropriate.
Seniors with limited English skills can be especially vulnerable, which is why the state’s Senior Medicare Patrol issues fraud warnings in multiple languages, including Chinese, Farsi, Spanish, Russian and Vietnamese.
To avoid being lured into coverage that’s not appropriate, Nozaki offers these tips:
Do not move out of your Medicare plan unless you want to. Be leery of free prizes, giveaways or other gifts offered in exchange for signing Medicare forms. Beware of unsolicited phone calls or knocks at your door by people claiming to be Medicare agents. If someone calls saying you must switch Medicare plans to keep your doctor, contact the doctor’s office yourself to confirm. Never give out your Social Security or Medicare number to strangers.
Figuring out Medicare: Where to get help
For seniors 65 and older, the annual Medicare open enrollment season for Part C (managed care plans) and Part D (prescription drug coverage) is Oct. 15-Dec. 7. Not everyone needs to change their Medicare plan, but experts say it pays to review your current plan, especially for prescription drug coverage. Here are places to start:
HICAP: The Health Insurance Counseling & Advocacy Program (HICAP) offers free, year-round Medicare plan counseling in all 58 California counties. Call 800-434-0222 for an appointment. Its West Sacramento office, handling appointments in 30 locations in nine counties, is at: 916-376-8915.
University of the Pacific clinics: Free counseling on choosing the most cost-effective Medicare Part D prescription drug plan. Includes a personalized review of your medications. Hosted by UOP School of Pharmacy, the clinics are at varied sites in Lodi, Stockton, Tracy and the Bay Area, between Oct. 17 and Nov. 21. In addition to Part D counseling, seniors can get free flu/pneumonia vaccinations; cholesterol and diabetes testing; asthma, blood pressure, bone density, depression and memory decline screenings; and risk assessments for falling.
UOP’s only Sacramento-area clinic will be held Saturday, Oct. 24, from 10 a.m. to 4 p.m., at Christ Community Church, 5025 Manzanita Ave., Carmichael. For an appointment, call 916-375-3301. For more on UOP’s Medicare Part D clinics, call 209-932-2958 or go to: go.pacific.edu/medicare.
Medicare.gov: The official federal site includes a prescription-drug comparison tool.