Are your Medicare clients skipping life-saving medications to save money? Recent changes are helping to make prescriptions more affordable for Medicare enrollees, but cost is still a concern. Insurance agents can help by offering guidance and resources.
Retirees Often Take Multiple Prescriptions – And the Costs Add Up
Health conditions tend to increase with age, so it’s no wonder that retirees tend to take multiple prescriptions. In fact, research published in the Journals of Gerontology finds that more than one in three seniors takes at least five different medications.
The costs can add up quickly. A KFF survey found that 21% of older adults say they did not take a medication as prescribed at some point in the previous year due to the cost. Skipping or rationing medicine can lead to serious health problems, so this is a dangerous trend.
Strategies to Help Clients Afford Medicare Prescription Costs
When seniors select a Medicare plan, it’s important to consider the out-of-pocket Medicare prescription costs as well as the monthly premium. However, even if you pick a plan carefully, you may have trouble affording new prescriptions. Insurance agents can help by raising awareness of the many strategies and resources available.
If a prescription is too expensive, there may be options.
Medicare Prescription Payment Plan. This program lets Medicare enrollees spread out their out-of-pocket Medicare Part D prescription costs. Instead of paying the entire out-of-pocket amount at the pharmacy, they can pay via monthly installments. This allows them to pick up the prescription immediately even if they don’t have the cash on hand. All Medicare prescription drug plans are required to offer the Medicare Prescription Payment Plan, and enrollees who are interested should contact their drug plan.
Extra Help. The Medicare Extra Help program helps with Medicare prescription drug costs. This is a low-income subsidy, and in order to qualify, Medicare enrollees must meet resource and income requirements. Eligible enrollees have a $0 premium and deductible, and they only pay a maximum of $5.10 for generic drugs and $12.65 for brand-name drugs at participating pharmacies. Medicare enrollees can apply for Extra Help through the Social Security Administration.
Generic Alternatives. Doctors may sometimes prescribe expensive brand-name drugs when less expensive generic options are available. There may also be other medication options for the same condition that cost less. Medicare enrollees should talk to their prescribing doctor to see if any lower-cost alternatives are appropriate.
Discount Programs and Coupons. It’s sometimes possible to save money by using a discount program or coupon. According to Healthline, you CANNOT combine a drug coupon with Medicare coverage. However, if the discounted price or coupon price is less expensive than the Medicare copay, Medicare enrollees can use the coupon INSTEAD of their Medicare coverage. Note that the costs will not apply to their Medicare deductible or annual spending cap if they do this. To see if discounts are available, contact the drug manufacturer or use a program like GoodRx or Cost Plus Drugs.
Pharmacy Selection. The pharmacy you use can affect how much you pay for a prescription. Medicare Part D plans typically have participating pharmacies that accept the coverage, but these pharmacies can be tiered, and the copay at a “standard” tier pharmacy may be significantly higher than the copay at a “preferred” tier pharmacy. Medicare Part D plans may also provide mail-order programs that allow enrollees to buy a three-month supply that’s delivered directly to their home, often at a discounted price. This option can be particularly convenient and cost-effective for long-term prescriptions. To see what pharmacy options are available, contact the drug plan.
Enrolling in a Medicare Plan Is Just the Beginning
For Medicare beneficiaries, enrolling in a plan is just the beginning. Actually using the plan throughout the year is what really matters. Medicare insurance agents can help their clients maximize the value of their benefits so they can take care of their health and finances.
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