Medicare drug plans cost go up

Published 9:00 pm Monday, November 9, 2015

Despite claims that health care costs are coming down, the consulting and research firm, Avalere Health recently reported that premiums for the 10 most popular prescription drug plans (PDPs) will increase an average of 8 percent next year. That’s going to impact many in western North Carolina and nationwide. Of those top ten plans, five of the most popular are raising premiums even more, from 16 to 26 percent higher than last year’s premium rates.

This may come as a surprise to many seniors, but the fact is that announcement of the increases were included in the annual plan notices that all plan providers must send to their enrollees by the end of September, as well as being heavily covered in by the mainstream news.

Most of these increases do not impact seniors who have Medicare Advantage Plans that typically cover the deductible for Medicare Part A and Part B, and in some cases, the Part D prescription deductible – $360 in 2016 – and most of the costs of basic prescription medicines.

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For those who have traditional Medicare, which is an 80/20 plan with Medicare paying 80 percent of the approved amounts and you responsible for the remaining 20 percent, it’s a good idea to buy a Medicare Supplement or Medi-Gap insurance plan.

“Gap” plans usually pay for the initial Part A hospital deductible – $1,260 in 2016 – that is charged every time that you’re admitted to the hospital. Supplements also pay most of the entire amount your doctor or outside medical service provider charges in excess of the 80 percent that Medicare reimburses them for their services. That amount is typically about 20 percent of the total charge, and without a supplement or Gap plan, individuals have to pay those charges out of their own pockets.

With the traditional Medicare 80/20 plan, be aware that it doesn’t cover prescription drugs. You’re required to purchase a prescription drug plan (PDP) or face a financial federal penalty which is applied to your monthly premium if and when you do purchase a PDP plan.

Also keep in mind there’s a coverage gap in prescription drug plans – known as the “donut hole.” That’s when neither Medicare nor your PDP insurance pays for your prescription drugs.

In 2016 that gap begins when you and your insurance company have spent a combined amount of $3,310 on drugs. The prescription coverage does not resume until the amount spent for prescriptions reaches $4,850. That means under most plans once you and your plan have hit the “donut hole” of $3,310, you will pay the next $1,540 out of pocket until the amount spent equals $4,580 and coverage continues.

As you review your current plan, look at more than just the premium being charged. Check to see how well the plan you have or are considering matches your prescription medication needs. Look carefully at the “formulary” (drug list) in a plan to be sure it includes some or all of your medications, particularly the more expensive drugs. Check to see if cost-sharing (a deductible) is required and whether any special rules apply.

The time to review your 2016 Medicare, Supplement, PDP or Advantage Plan is right now.  Be sure your plan will cost effectively continue to work for you. You can change PDP plans or consider changing from traditional Medicare with a supplement and PDP to an all-inclusive Medicare Advantage program during the open enrollment period that ends Dec. 7, 2015.

For assistance, contact a Medicare expert or call North Carolina Seniors’ Health Insurance Information Program (SHIIP) – 855-408-1212.

Ron Kauffman is a consultant and expert speaker on issues of aging, Medicare and Obamacare. Ron is the author of Caring for a Loved One with Alzheimer’s Disease, available as a Kindle book on His podcasts can be heard weekly at Contact Ron at 828-696-9799 or by email at