Out–Of–Pocket Costs Catch You By Surprise? How To Avoid "Sticker Shock"
If you're suffering "sticker shock" from higher co-pays and co-insurance than expected, chances are it might be due to smaller networks of providers in your health or drug plan. It's possible you can cut the high costs, but the secret is using the "preferred provider networks" that participate in your Medicare Advantage or prescription drug plan.
To avoid unexpected out-of-network costs:
- Check your health plan's provider networks, and do so at least once a year.
- Use your health plan's website, or call customer service to learn if your doctor, hospital, pharmacy or other provider is in your plan's network, and a "preferred provider."
- Ask if your plan ranks providers in "tiers" – the higher the tier, the higher your co-pay.
- Call and confirm your information with providers directly to learn whether he or she is still participating in your health plan.
- Review your health and drug plan changes next October and compare your choices during next fall's Medicare Open Enrollment Period, October 17 through December 7. Switch when you can find a better choice for you.
Case in point: I helped my neighbor Irene compare and switch to a new Part D plan for 2014, a move that will cut her estimated drug costs by more than 50% this year. Humana's new Walmart Rx Plan will save her $333 in premiums in 2014 compared to what she would have paid if she stayed in her previous drug plan. In addition, she will lower her annual costs on the prescriptions she takes from $276 to $168.
But there's a very important trade off – Irene will need to fill all her prescriptions through Walmart, rather than use our small, but popular, local independent pharmacy. The estimated cost of Irene’s drugs would be $928 higher if Irene goes outside the Humana Walmart network. While that's not a problem for Irene or her daughter who picks up the prescriptions, it's important to understand how much more Irene’s prescriptions would cost if filled by a non-network pharmacy.