Changes in Medicare drug, health plans

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Bill Salganik

If you’re not paying attention, your Medicare prescription premium could increase by more than $50 a month in 2016. Each year, insurance companies can — and do — change their premiums, copays, deductibles and lists of covered drugs.

It’s always a good idea to re-shop for your Medicare prescription drug and/or health plans (such as HMOs) during open enrollment, which lasts from Oct. 15 to Dec. 7. Changes you make will take effect on Jan. 1.

If your Medicare prescription plan is changing, you need to take action to make sure your coverage works for you next year — perhaps even to be sure you’ll have coverage at all.

One prescription plan, for example, Transamerica Rx Classic, is raising its monthly premium from $29.40 to $83.50. Among health plans, Aetna is dropping both of its current HMOs and adding a new HMO plan. And there are new health plans from two familiar names, University of Maryland Health and Johns Hopkins.

Here’s a look at some of the major changes, and their implications for members and prospective members.

Health plan changes

New to the market: Howard County has no Medicare PPOs this year, but next year Johns Hopkins will be offering two such plans. (Like HMOs, PPOs have a network of participating doctors and hospitals, but unlike HMOs, they offer some out-of-network coverage.)

For HMOs, University of Maryland Health is also entering the Medicare health plan market with one plan, and two other current sponsors (Aetna and Cigna-Health Spring) are adding plans. Kaiser Permanente is also adding a new Cost Plan to its range of plans.

Leaving the market: Aetna’s current HMOs will end Dec. 31.If you are enrolled in either of these Aetna HMOs and do nothing, in January you will have Original Medicare (Parts A and B) and no prescription drug coverage.

During open enrollment, Aetna members can pick a different health plan or pick a Medigap plan without having to answer health questions. If you go with the Medigap plan, you will also need to select a Medicare drug plan.

You will also get the opportunity to select new plans at the beginning of 2016 (January and February), but coverage will not be retroactive back to Jan. 1.

Drug plan changes

New to the market: There’s one new drug plan, Magellan Rx Medicare Basic.

Leaving the market: Four drug plans are leaving the market — Aetna Medicare Rx Premier, Cigna-HealthSpring Rx Secure-Max, Transamerica Rx Choice and SmartD Rx Saver.

If you are currently a member of one of these plans, and you do nothing, you will automatically be switched into another plan Jan. 1. Your new plan may have a very different cost and benefit structure, and may not cover your medications. If you’re in one of the four discontinued plans, it’s very important that you review your options to see what plan will work for you in 2016.

Added deductibles: Two plans that don’t have deductibles in 2015 are adding them for next year: Cigna-HealthSpring Secure Extra ($250) and Symphonix Primesaver Rx ($200).

Express Scripts Medicare-Choice is raising its deductible from $50 to $360. That’s the new maximum deductible for 2016, and about a dozen plans are moving up from the current maximum of $320.

One plan, First Health Value Plus, is fully eliminating its deductible for next year.

Higher premiums: While seven plans will have lower premiums next year, 16 have boosted their premiums. For nine of those plans, the increase is more than $10. In addition to Transamerica Classic ($54.10 increase), others with $10-plus hikes are Cigna-HealthSpring Secure Extra, Express Scripts Medicare-Choice, Humana Enhanced, United American Enhanced, United American Select, United American Essential, AARP MedicareRx Preferred and WellCare Extra.

Keep in mind that the monthly premium is only part of your total costs, and that you need to also consider the deductible and copayments.

Extra Help changes: For those getting federal Extra Help with prescription costs, Extra Help will no longer cover the full premium for Transamerica RxClassic (you will be responsible for $50 each month), but will newly cover the full premium for WellCare Classic.

Sanctioned plans: All United American plans (Essential, Select and Enhanced) are on Medicare sanctions. This means that current members can stay in the plans, but no new members can enroll. Medicare’s online Plan Finder tool will not show United American’s information. Current members can call United American to get information for 2016.

Name changes: Symphonix Rite Aid Premium is now Symphonix PrimeSaver Rx. Symphonix RiteAid Value Rx is now Symphonix Value Rx.

The Howard County State Health Insurance Assistance Program (SHIP) can help you review your options at no charge, with one-on-one appointments, including on several evenings and Saturdays during open enrollment. Call (410) 313-7392 for information.

Bill Salganik is a counselor with the Howard County State Health Insurance Assistance Program (SHIP).