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Medicare News

Strange Pricing Details Can Bedevil Medicare Beneficiaries Choosing Drug Plans

Medicare advocates urge seniors to compare plans each year to find a way to save money, but many find the process so complex that they don’t switch

By Susan Jaffe, The KHN Blog

Medicare Open Enrollment
Oct. 15 thru Dec. 7

When people with Medicare can choose plans for 2014

Click to Medicare Site

Nov. 13, 2013 - Pharmacist Gina Upchurch knows all the ins and outs of the Medicare prescription drug benefit and was sure she discovered something very wrong:  using the government’s online plan finder tool to help seniors compare dozens of 2014 drug policies, she noticed that some insurers charge higher prices for a prescription filled every two or three months compared to the same drug bought every month.

“You’re buying less and paying more,” said Upchurch, executive director of Senior PharmAssist, a nonprofit group in Durham, N.C.

Seniors have until Dec. 7 to sign up for drug coverage next year. Medicare advocates urge beneficiaries to compare plans each year because they may find a way to save money, but many people find the process so complex that they don’t switch plans. 


Related Stories


Seniors Have More Reasons to Switch Medicare Prescription Drug Plans, Consultant Says

Editor’s Note: The window is open at Medicare for seniors to change the way they receive benefits in 2014 (open through Dec. 7). Most of the attention is focused on the Part D prescription drug plans, which tend to change – some drastically – from year to year. Below is an analysis provided by Allsup, a company that markets health plan consulting advice.

Nov. 4, 2013

See links to more news on Medicare Open Enrollment for 2014 below this news story.

Read the latest news
> Medicare
Medicare Drug Program

> Senior Politics
> Today's Senior Headlines


Medicare’s plan finder allows seniors to narrow their choices by entering their drugs, dosages and pharmacy preferences, to obtain a list of available plans and their premiums, deductibles and drug costs.

Eye drops, creams, or inhalers are drugs that can last more than a month, although some insurers don’t offer discounted pricing for other than 30 days, said Upchurch.  For example, under one plan she reviewed, a beneficiary who has a monthly prescription for eye drops would pay $7 a month during the initial coverage period to get the drug, while another person who has a prescription for the drops to be filled every 60 days would pay $51.  She also said that two plans she compared charge $40 or $45 for three vials of insulin every month in the initial coverage period, and $575 every two months.

She noted that seniors sometimes can get the lower prices if they use pharmacies or mail order programs designated by the insurers, rather than just picking one themselves.

Although price disparities might be confusing, a Medicare spokesman said, they are aimed at providing more accurate information about the plans. “These features are not problems with the plan finder.”

He pointed out that a footnote on a different web page with plan details explains why a small supply of a drug can cost more than a larger one: “This drug is covered by the plan, however, the plan does not offer a benefit for the frequency and pharmacy type you selected.  Therefore, the cost displayed is an estimate of the full cost of the drug for the frequency entered.”

If seniors are taking a medication with a frequency other than once a month, they should call the drug plan to verify costs and ask if there is a lower price at the plan’s preferred retail or mail order pharmacy, said Fred Riccardi, director of client services at the Medicare Rights Center, a consumer advocacy group in New York City.

“But people shouldn’t have to run around to different pharmacies,” said Upchurch.  “It would be better if Medicare required plans to cover whatever supply a provider prescribes.”

Susan Jaffe can be contacted at

Some of this information is reprinted from with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.


Medicare Open Enrollment 2014 - Related Archive Stories


No Increase in Cost of Medicare Part B in 2014; More Savings in Drug Program

CMS says major savings for Medicare beneficiaries next year; good news for seniors facing small Social Security increase - Oct. 28, 2013

Seniors Cautioned To Pay Close Attention To Details As Enrollment Begins In Medicare Plans

There’s a likely payoff for those who pay close attention to the details - enrollment open through December 7

By Susan Jaffe, Kaiser Health News, Oct. 16, 2013

Medicare Opens Enrollment for 2014 Plans, Says Plan Prices Holding Steady

See video in story on how to use the Medicare Plan Finder to compare available plans, make your selection; lead video about Open Enrollment period - Oct. 15, 2013

Good Summary of Your Medicare Coverage Options as Open Enrollment Begins

Window for making changes to your Medicare coverage opens October 15, closes December 7

Oct. 14, 2013 - With the Medicare’s open enrollment period opening on Tuesday, this is a good summary of the basics about Medicare health insurance – what is available to keep you healthy with plans that meet your needs. It is by Pamela Yip, a business writer for the Dallas Morning News, who regularly covers Medicare. Click to Dallas Morning News


Analysis Finds Good News on 2014 Medicare Prescription Drug Premiums

Overall stable or lower cost options available to seniors finds HealthPocket study

Oct. 11, 2013

Medicare Advantage Plan Out-of-Pocket Caps for 2014 Look Good For Consumers

Drug plans with low cost-sharing limits and no premiums available: HealthPocket

Oct. 11, 2013

AARP Offers Tips, Guidance on Choosing Plans During Medicare Open Enrollment

Changes can be made to Medicare plans from October 15 through December 7; Distinction between Medicare and Affordable Care Act open enrollment is important

Oct. 10, 2013

Consumer Reports Ranks, Scores Medicare Advantage, Other Health Plans for 2014

CR finds that higher cost does not mean better care; complete report in magazine, rankings free online, Medicare open enrollment starts October 15

Oct. 5, 2013

Understanding the Difference between Medicare and the Health Insurance Marketplaces

Marketplaces are for people who do not have insurance, people on Medicare are insured by Medicare

By Ron Pollack, Executive Director, Families USA

Oct. 1, 2013

Senior Citizens Need to Get Ready for Medicare Open Enrollment

Seniors covered by Medicare do not need to buy health insurance on the Health Insurance Marketplace - Medicare Open Enrollment starts October 15

Oct. 1, 2013

As Medicare Open Enrollment Nears More Seniors Opting for Quality Medicare Advantage Plans

Open enrollment begins October 15 and ends on December 7; period when those in Medicare can choose new health and drug plans

Sept. 19, 2013

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> Medicare   > Medicaid   > Senior Politics  > Today's Headlines


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