Seniors, look out. Your Medicare plan may have checked out.
Locally, thousands of seniors are expected to lose their current Medicare prescription drug or health plans under tentative changes announced for 2017. That means they’ll need to choose another plan during this year’s open enrollment season, which runs Oct. 15 to Dec. 7.
“We are already getting calls from folks who got the notices that their plan is ending. They’re somewhat panicked,” said Mariko Nakabayashi, acting managing attorney for the Health Insurance Counseling & Advocacy Program office in Sacramento, which provides free, year-round counseling for Medicare patients.
Although final numbers will not be released until mid-October, Medicare officials say a number of current Part D prescription drug plans and Medicare Advantage plans are exiting the California market, starting in January. More than 11,700 seniors in Sacramento, Placer and Yolo counties who have Medicare Advantage plans are likely to be affected, according to Nakabayashi.
A number of Part D prescription drug plans also are disappearing next year.
“Four (prescription drug) plans are going away completely. That’s significant,” said Rajul Patel, who said 24 Part D plans will be offered next year in California, instead of the current 28. In addition, maximum deductibles are increasing and some medications may be dropped entirely.
That’s why it’s imperative that seniors look closely at their current plan during this year’s Medicare sign-up season.
“Think of this like an annual checkup with your primary care doctor, just like with a physical. Every year, substantive changes (to Medicare plans) will happen,” said Patel.
On Oct. 22, UOP and HICAP are co-hosting a free health fair in Carmichael to help seniors wade through their annual Medicare choices. Other free clinics are being held throughout the region. (See box for details.)
“Understanding Medicare terminology is confusing to most folks. When you start piling on all the options and types of plans, it gets very confusing very quickly,” said Nakabayashi, whose HICAP program is run through Legal Services of Northern California. “Beneficiaries become paralyzed because there are too many choices … or get stuck in a plan with high costs or that doesn’t cover all their medications.”
Seniors should carefully read their annual “Notice of Change” letter from their current providers, which outline any changes for 2017. Those letters, which usually arrive in mailboxes in September, could include changes in premiums, deductibles, covered medications, even doctors.
Annual changes among Medicare plans are not surprising, according to federal officials.
“Private companies that offer Medicare Advantage and Part D prescription drug plans come and go every year,” said Jack Cheevers, San Francisco-based spokesman for the federal Centers for Medicare & Medicaid Services, in an email. “They make decisions on whether to enter, stay in or leave a particular market based on business reasons.”
Even if your Part D provider isn’t leaving California’s market, there could be prescription drug cost increases and medications dropped from your current coverage. The diabetes medication you’re taking this year, for example, may not be offered in 2017 because your existing prescription plan is switching to a cheaper alternative.
Another 2017 difference: The maximum deductible for prescription drugs will be as high as $400, compared with $360 this year.
By comparing Part D plans, individuals could see “significant out-of-pocket cost savings,” said Patel, noting that about 80 percent of beneficiaries save an average of about $1,011 a year by switching their prescription drug plan.
At the Oct. 22 event, UOP pharmacists and pharmacy students also will offer free advice on whether your medications could potentially interfere with one another or have dangerous side effects.
“We probably find one in 10 patients where we need to contact their prescriber because of a potentially dangerous situation,” said Patel. For instance, it could be a sleeping medication whose side effect is a high level of morning drowsiness, putting seniors at increased risk for falling.
In those cases, UOP counselors will send a notification to the person’s physician, suggesting a change.
Patel has been running the Medicare pharmacy clinics for 10 years but this is only the second time in Sacramento. Last year, he said, about 1,400 individuals took part in six counties: Sacramento, Alameda, Santa Clara, San Francisco, San Joaquin and Stanislaus. This year’s Sacramento clinic will have about 25 pharmacists and 90 pharmacy students available to counsel seniors in several languages, including Spanish and Cantonese.
One thing that doesn’t change during Medicare’s open enrollment season: scammers. Medicare specialists are warning seniors to be wary of unscrupulous insurance sellers, who often intensify their efforts during the annual sign-up season.
“It’s only a tiny percentage of agents who are rogue … who talk (seniors) into signing up for a health plan that is not right for them,” said Micki Nozaki, state director of Senior Medicare Patrol, a federally funded program to thwart Medicare fraud. Every year at this time, she said, some seniors are pushed into inappropriate plans that don’t include their current doctors or charge higher costs for prescription drugs.
Seniors should not feel pressured by “early-bird discounts” or special offers to switch Medicare plans, Nozaki said. She also warned seniors to not take unsolicited phone calls, door-to-door solicitations or emails about Medicare plans.
California’s Senior Medicare Patrol website, sponsored by California Health Advocates, offers tips in Spanish, Hmong and other languages on how to avoid being conned into the wrong Medicare plan. Or call Senior Medicare Patrol at 855-613-7080.