This story originally appeared here and is published on Carolina Public Press through a content-sharing agreement with the North Carolina Health News.
By Rose Hoban
Every year, hundreds of people come to Gina Upchurch telling her that they’re happy with their Medicare prescription drug benefits and every year, Upchurch saves those same people money by helping them change their plans.
Seniors are given the opportunity to review their Medicare Part D pharmacy plans each fall. And as the annual election period for Medicare pharmacy benefits comes to a close on Dec. 7 (this Friday), Upchurch, the head of Durham’s Senior PharmAssist program, is still telling seniors that they would do well to compare drug plans.
“We just published an article in the Journal of the American Pharmacists’ Association where we found that two-thirds of the folks we see need to change drug plans,” said Upchurch. “That’s every year.”
Upchurch’s study also showed seniors who switched had an average savings of $547 over the course of a year.
But research has found only 10 percent of seniors take advantage of the annual election period to review their plans and see if a different one would work better for the coming year.
According to spokeswoman Kerry Hall from the N.C. Department of Insurance, fewer than 40,000 of the North Carolina’s 1.5 million Medicare beneficiaries have called to get review their plans.
“It’s important to review and compare plans every single year because people miss opportunities to save money because they stuck with the same plan. The plans change every year,” Hall said.
Angela Meyer, 70, said she found the whole process confusing, but was grateful she could get guidance from Upchurch’s organization, which serves only Durham county. There are organizations in every county who have counselors to help seniors make their choices.
“The hardest thing about Medicare is comprehending the system,” said Meyer, who lives in Durham. “It’s like it’s intentionally too complex.”
A senior can enter his or her drugs on the website Medicare.gov or can call a hotline at the Seniors’ Health Insurance Information Program (SHIIP), 1 (800) 443-9354 to review and change plans.
But the process is the same: Someone has to get on Medicare.gov to compare pharmacy plans to the drugs taken, the pharmacy used, and how much a beneficiary wants to spend on a plan per month. With dozens of plans to choose from in every county, it’s impossible to make the comparisons without using the website.
And that intimidates many seniors.
Changes this year
“I wasn’t sure whether to change my Part D plan because it gave me such a good deal, ” said Meyer, but because her medications have changed, she reluctantly agreed to compare.
Upchurch said many drug prices have soared in the past year, and that can affect people’s plans.
Insulin, for example, has doubled in price. So, some pharmacy plans that may have covered the total cost of insulin last year might not reimburse at the same level now.
And Upchurch said there’s an extra wrinkle to the selection process this year. Many chain pharmacies are now making deals with insurers to give deeper discounts to seniors with drug plans from one insurance company over another.
She said that can add an additional layer of confusion for seniors who may get Medicare hospital and doctor coverage from one insurance company, but drug coverage from another.
Upchurch said many seniors are reluctant to change plans, and they’re even more reluctant to go to a new pharmacy where they might not know the people behind the counter.
“Insurance companies are working with pharmacies to drive people to certain pharmacies,” Upchurch said. “Of the 30 standalone drug plans in Durham, 15 of them co-brand with an insurer. They say we’ll drop your prices if you sign up with that insurer over this one.”
“The pharmacy you put in can help drive what plan shows up least expensive in the Medicare website, that’s not really happened before,” Upchurch explained. “And vice versa is also true. The plan you put in will ultimately be cheaper at different pharmacies.
But making those comparisons on the Medicare.gov website isn’t so easy.
“Of course you can only put in two pharmacies at a time, so you can’t see that unless you sit there and put all the different pharmacies in to find the least expensive plan,” Upchurch said.
Millie Johnson, 66, just retired and got on Medicare in the past year. She said the amount of information she’s received has been dizzying.
“You get so much in the mail, I don’t know what to do,” said Johnson,who came to Senior PharmAssist for advice on what to do.
When asked if she got help in making a decision about her drug plan, Johnson smiled.
“It went well… I’m very pleased.”