Ways I Might Pay Less For Medicare in the Future

At the beginning of the year I, like some of you, neglected to research alternatives to original Medicare Part B. I was so busy battling an incorrect medical bill and an exorbitant government-subsidized rent increase that I failed to notice the increases in my social security and premiums for Medicare Part B and D slated for 2018. For the fourth time in as many months, I hit the roof. The Medicare premium increases have caused my social security income to drop by 12 dollars a month in 2018!

I’ve got a choice to make

Of course I realized this after the December 7th 2017 deadline to change Medicare plans which means I’ll have to wait until October 2018. That gives me several months to do research and decide whether I would actually save money by choosing something different. It’s going to be a choice between:

  • A Medigap supplement,
  • A Medicare Advantage plan, or
  • Staying on original Part B and Part D coverage.

Factors to consider

There are several factors that will affect my decision:

  • I must carefully research and write down all my prescriptions and then find out from the Advantage plan rep whether those drugs are in their formulary. If they don’t cover my Tier 5 MS drugs (and any others I won’t compromise) then I can immediately eliminate that insurance plan.
  • Write down all my treating physicians’ names and phone numbers. It’s important to find out if the plan is an HMO or PPO. If it’s an HMO I might be limited to their choices of doctors. This would be a deal-breaker for me and for most MS patients since we usually have established long relationships with specialists we’ve hand-picked ourselves.
  • Some Advantage plans have no monthly premium. Sound better than paying Medicare B’s $134 per month premium and an additional Medicare Part D premium? Not so fast. As usual, there is no free lunch. Zero-premium Advantage plans usually charge higher copays and deductibles. I’ll have to keep my calculator handy to tally up the real costs and find out if it’s actually a savings.
  • Medigap plans cover Part B copays, coinsurance and deductibles only, with no drug coverage. On top of paying a monthly premium for the Medigap plan, you still have to pay Medicare Part B premiums and a Part D drug plan premium.

Copay assistance programs

Another important factor for Medicare patient receiving copay assistance is if you are earning less than 500% of the Federal Poverty Guideline then you’re probably getting copay assistance. Since I take Tecfidera and Ampyra, I have access to Biogen’s and Acorda’s patient assistance programs however being on government insurance disqualifies me from their assistance programs, so I get copay assistance from a charity organization that covers people with government insurance.

Requirements

Before I go shopping around for a Medigap or Medicare Advantage plan, though, I must consult a list of conditions that my charity organization requires to qualify for their copay assistance. Of most importance is that:

  • If I choose a Medicare Advantage plan, it must include drug coverage that covers my MS medications.
  • If I choose Medicare Part A and B plus Medigap, I only qualify for assistance if my drug plan does not cover my drugs.

Consult the customer service hotline

Confusing? That’s why I will first call the organization’s customer service hotline and ask whether the plans I’m considering will disqualify me for copay assistance. It’s a real pain to have to take on this kind of project, but it’s all part of self-advocacy. While this might be a headache during the process, I could end up saving money after it’s over and that makes it worthwhile.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
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