Medicare Prescription Drug Plan Changes: What Beneficiaries Need to Know
Jude Pare, a retiree in rural Minnesota, faced an unexpected challenge upon returning from his winter stay in Arizona: his Medicare prescription drug plan was canceled due to an unpaid premium of $28.80. This left him without coverage for a necessary medication, which would cost approximately $1,800 out of pocket every 90 days. Pare and his partner, Diane Tix, were unaware that their previously premium-free Medicare drug plan had introduced a monthly charge.
This situation is not unique to Pare. According to a report by KFF Health News, numerous beneficiaries of the Wellcare Value Script prescription drug plan found themselves in similar situations when their plans, which once had no premiums, began enforcing monthly charges. The report indicated that beneficiaries across 32 states and Washington, D.C., could experience similar issues if they remain unaware of changes to their no-premium plans.
In a related case, Wayne Bennett, a 74-year-old from Durham, North Carolina, lost his medication coverage after failing to pay a newly introduced premium of $3.60 per month. Bennett, who manages his health with nine different prescriptions, managed to refill his medications before his coverage expired, but remains uncertain about future costs.
These new premiums align with significant changes to Medicare's prescription drug benefits, marking the largest restructuring of the system since Part D's inception in 2006. This overhaul includes capping out-of-pocket expenses for most beneficiaries at $2,000 annually, shifting more costs to insurers and Medicare. Consequently, some insurers have started charging premiums on plans that were previously free of charge.
Centene, parent company of Wellcare, stated that members of their Value Script plan were informed of these changes through the Annual Notice of Change, supplemented by reminders via mail, phone, email, and text messages. A Centene representative acknowledged the disruption caused by losing coverage and emphasized their commitment to assisting members in understanding their options.
Key Takeaways for Medicare Beneficiaries
This scenario serves as a crucial reminder for Medicare beneficiaries to carefully review their plans during the open enrollment period each year. Changes in premiums, deductibles, covered medications, and pharmacy networks can occur even if a plan's name remains unchanged. For those like Bennett, who do not qualify for a special enrollment period, re-enrollment in an alternate prescription drug plan will be necessary once the next enrollment window opens.