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Some Medicare Rates to Rise

Posted Mon Oct 12, 10:25 am ET

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What is going to happen to rates for Medicare Part D prescription-drug plans next year? Can I switch plans?

Prices for both Medicare Part D prescription-drug plans as well as Medicare Advantage plans are going to rise in 2010. And you have from November 15 to December 31 to decide whether you want to stay in the same plan or switch plans for 2010.

Average premiums for Part D plans are increasing by 7% in 2010, to $30 per month, and average premiums for Medicare Advantage plans are jumping by 22%, to $39 per month. These price hikes may be particularly tough to stomach next year, when Social Security will not have a cost-of-living increase.

And premium increases are only part of the picture. More than 60% of Part D plans will charge an annual deductible in 2010 ($310 is standard) before covering any drug costs, up from the 45% that charged a deductible in 2009, according to the Kaiser Family Foundation. Fewer Part D plans will provide coverage in the so-called doughnut hole, which begins after you reach $2,830 in total drug spending and extends until your total drug costs for the year reach $6,440 in 2010; within that gap, you generally have to pay all the bills yourself. The plans that do provide some coverage in the doughnut hole cover only the cost of generic drugs; otherwise, you're on your own.

And be sure to check how each Part D plan treats your specific medications: Co-payments are rising, and many insurers are changing formularies. For example, you could end up with higher out-of-pocket costs if your insurer switches your drug from preferred to co-pay nonpreferred. Ask your doctor whether you can switch any of your drugs to a generic or lower-cost medication; the policy with the best deal for brand-name drugs may not be the best deal for generics.

The Medicare prescription-drug-plan finder is an excellent tool to analyze the costs of Part D plans for your situation. Type in your drugs and dosages, and you'll see total out-of-pocket costs -- premiums as well as co-payments -- for your medications throughout the year. Or call 800-633-4227 for personalized assistance.

This year's premium increases come on top of previous cumulative price hikes. Premiums for AARP MedicareRx Preferred, the most popular Part D plan, have risen by 50% since 2006, according to Avalere Health, a health-care consulting firm. Premiums for Humana Enhanced, also a popular plan, have increased by 180% over the same time period.

If you're struggling to afford the premiums for Medicare Part B, a Part D prescription-drug plan and a medigap policy, consider going with Medicare Advantage, which provides medical as well as prescription-drug coverage through a private insurer (it may also include dental and vision care). Almost 87% of Medicare beneficiaries will have access in 2010 to a low-cost Medicare Advantage plan that charges no premium above the cost of Medicare Part B.

These plans, too, have their drawbacks. Many are boosting premiums and increasing co-payments for doctor's visits, hospital stays and prescription drugs. You may have to pay much more out of pocket for certain types of treatments, such as chemotherapy, than you would with Medicare and medigap. And be sure to find out whether your providers participate in the plan (the least-expensive plans, Medicare HMOs, have the tightest restrictions on doctors and hospitals).

If you are already enrolled in a Medicare Advantage plan, you should receive an annual notice of change in late October that outlines any differences in your plan's coverage and costs from 2009 to 2010, which should be a key piece of your research, says Donna Burtanger, senior director of Medicare for SilverLink. To find out about prices and coverage for plans available in your area, as well as customer-service ratings, go to the Medicare Options Compare tool at Medicare.gov.

Many people are concerned that Medicare Advantage plans will leave the business if Congress passes a health-care reform plan that cuts back on subsidies to private insurers. If your plan does shut down, you may switch to another Medicare Advantage plan or move back to traditional Medicare. If you do, insurers must offer you medigap plans A, B, C or F regardless of your health (otherwise, the price of a new medigap policy may be based on your health, unless you signed up for Medicare Part B in the past six months).

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