(The writer is a Reuters columnist. The opinions expressed are
By Mark Miller
CHICAGO, Oct 12 Medicare will cost you more in
2017 - all the more reason to scrutinize your coverage as the
annual open enrollment gets under way this weekend.
Open enrollment - which runs from Oct. 15 to Dec. 7 - is the
time of year when Medicare enrollees can switch their Part D
prescription drug coverage. They also can move in or out of
Medicare Advantage - the managed-care alternative to
traditional, fee-for-service coverage - or change providers.
Premiums and other out-of-pocket Medicare costs will be
higher in 2017. The Medicare Part B premium may jump 22 percent
to $149 for some enrollees, although final numbers will not be
released until later this month.
The higher premium amount would be charged to enrollees who
are not "held harmless" under the program's rules, which do not
allow the Part B premium to rise at an amount greater than the
annual Social Security cost-of-living adjustment. The higher
premium will be charged to enrollees, people not yet receiving
Social Security and more affluent beneficiaries subject to
Meanwhile, the Part B deductible for all enrollees is
expected to jump to $204 from $166.
Premiums for many of the most popular Part D prescription
drug plans also will rise next year. The one bright spot on cost
is Medicare Advantage, where average premiums are expected to
dip next year.
If you use traditional fee-for-service Medicare and have
only a Medigap supplemental plan - and you are happy with what
you have - there is no need to do anything during annual
enrollment. But it makes sense to re-shop coverage if you have a
Part D prescription drug plan or are enrolled in Medicare
Yet very few Medicare beneficiaries bother to re-shop their
coverage during annual enrollment - just 10 percent of Medicare
Advantage enrollees do so, according to a recent study by the
Kaiser Family Foundation (KFF). Those who did shift Advantage
plans between 2013 and 2014 saved $190 annually on their monthly
premiums on average, and lowered their out-of-pocket limit by
$401, the study found.
For the civic-minded, there is another reason to shop:
adding a dose of competitive pressure to the Medicare
marketplace. "It helps the system get better," said Philip
Moeller, author of "Get What's Yours for Medicare: Maximize Your
Coverage, Minimize Your Costs" (Simon & Schuster, October 2016).
"When people shop, that consumer behavior helps discipline
the marketplace and keeps it honest."
Here is an overview of trends in the Medicare market for
2017, along with tips for smart shopping.
Start by reviewing the Annual Notice of Change that Medicare
sends by mail in late September each year. The notice lists all
changes to your coverage for the coming year.
Odds are that your current premium will be higher next year.
Among the 10 most popular Part D prescription drug plans,
premiums will rise an average of 4 percent next year, according
to Avalere Health. The maximum deductible allowed by Medicare in
2017 also will be higher - $400, up $40 from this year (actual
deductibles vary among plans).
Shoppers should not base their selection on premiums alone,
cautions Frederic Riccardi, director of client services for the
Medicare Rights Center, a nonprofit advocacy group. "You should
look at the premium, deductibles, co-insurance and any plan
restrictions on the drugs you take," he said.
Part D plans routinely change their formularies - the list
of medications that are covered - and the rules under which they
are covered. For example, a plan might decide to restrict the
quantity of a medication or require "step therapy" - a
requirement that you try a less expensive alternative to the
drug prescribed by your doctor. And it could drop coverage of
your medication altogether.
In the Medicare Advantage market, premiums look stable for
next year - in fact, the average premium will fall 4 percent, to
$31.40 monthly, according the Centers for Medicare & Medicaid
Services (CMS), which administer the Medicare program.
Medicare Advantage often saves money for enrollees by
eliminating the need for separate drug coverage and Medigap. But
the trade-off is less flexibility in choosing your healthcare
providers - and Advantage plans are free to add and drop
providers. The annual enrollment period provides the opportunity
for enrollees to review the list of included providers, to make
sure they meet your needs.
Reviewing the list of in-network providers can be difficult.
Providers are not listed on the Medicare Plan Finder, and a
recent study by KFF found that the information available from
plan providers can be difficult to review, out of date and
frequently contain inaccurate information (reut.rs/2dSAfRq).
The best online tool for shopping plans is the Medicare Plan
Finder at the Medicare website (bit.ly/1AezyE7) . Plug in
your Medicare number and drugs (you will need each drug's name
and dosage). The tool then displays a list of possible plans,
their estimated cost, premiums, and deductibles; which drugs are
covered, and customer-satisfaction ratings. The finder also will
give you advice about drug utilization and restrictions.
Advice also is available from Medicare's toll-free number
The Medicare Rights Center maintains a free telephone
hotline (1-800-333-4114) that can walk beneficiaries through
differences between traditional Medicare and Advantage plans,
and help with selecting PDP and Advantage plans.
Federally funded State Health Insurance Assistance Programs
(SHIP) can also provide this kind of free assistance. Find your
local SHIP here: bit.ly/1OU0sfN.
(Editing by Matthew Lewis)