Whether insured or not, necessary prescription drugs can force a lower-middle class patient into poverty. That’s why hundreds of thousands of people are choosing to take fewer drugs than they need, some skipping treatment altogether because they simply can’t afford it. A study by the Annals of Internal Medicine proves that almost 5% of people with prescriptions valuing $50 or more abandon those prescriptions at their pharmacies.
When people skip out on the drugs they need to survive, they get sicker and end up spending more time in the hospital. Either way, they’re stuck. They can pay thousands each month for the drugs they need, or they can pay thousands each month for hospital treatments. Welcome to the vicious cycle of unaffordable health care and coverage.
Encouraging clients to select plans with higher premiums and lower copayments may ease this problem. Clients are more likely to pass on a drug if they are asked to hand over more money in the store than if they are essentially pre-paying for it every month. Stand-alone prescription drug plans (Part D’s) typically have higher copayments and lower premiums, which is great for clients who don’t have expensive prescriptions. However, clients who are taking multiple drugs each month may be better off with a Medicare Advantage plan which will help them to both decrease their copayments and cover greater hospitalization charges.
Medicare Advantage clients may have higher premiums, but they’ll never have to worry about not having coverage (with the exception of hospice care) or high copayments. The only other downfall to selecting Medicare Advantage over a Part D plan is the resulting smaller network. Clients may have to change doctors or pharmacies if they enroll in Medicare Advantage.
Naturally, clients will be more apt to choose the plan with a lower premium because they’d rather pay as needed for drugs, but with this choice, they are likely to pay more in the long run. Carefully explaining the benefits of a higher premium to your clients and encouraging them to choose Medicare Advantage over a stand-alone Part D plan may lower unmedicated rates. Remind your clients that they are legally required (under the ACA) to have not only Original Medicare but also a prescription drug plan. If they don’t enroll in either now, their costs for both will be higher later. Inform them of late enrollment fees, and encourage them to buy now, while you’re sitting in front of them and answering their questions.
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