Medicare Part D prescription drug plans are allowed to change their premiums, covered medications and preferred pharmacies each year, and many plans do. Plan participants are invited to switch plans once a year during the open enrollment period, but few Medicare beneficiaries actually pick a new plan. Here's why retirees are reluctant to change Medicare Part D plans and what might motivate them to do it.
The cost of the plan. Most Medicare beneficiaries consider the premiums and deductibles when initially selecting a Part D plan, but they don't continue to shop around for the lowest cost plan each year, according to recent findings from a series of focus groups with Medicare beneficiaries in Baltimore, Seattle, Memphis, Tennessee, and Tampa, Florida, conducted by the Kaiser Family Foundation and PerryUndem Research and Communication. Seniors in the focus groups said they tolerated and expected their premiums and copays to rise and would only start looking for a new plan if the price increase reached around $75 more a month. "People sign up for their plan maybe when they first come on Medicare, and they stay on their plan unless premiums really jump through the roof," says Tricia Neuman, senior vice president of the Kaiser Family Foundation. "It takes a big deal for people to make a change and insurers know that, so they can kind of raise their premiums, but not so much, if they want to keep people in their plan."
Covered medications. Medicare Part D plans have lists of covered medications called the formulary, which are tweaked from year to year. Seniors who need medications that aren't on their plan's formulary are often willing to try a number of workarounds including an alternative drug or a generic version that is covered, medication samples from a doctor's office, applying for discounts from drug manufacturers, appealing the insurer's decision not to cover the drug and ordering medications online, KFF found. However, some seniors say they would be motivated to change insurers if their plan stops covering a necessary drug, significantly increases the out-of-pocket cost or makes it difficult to obtain the medication due to preauthorization requirements or other restrictions.
Resisting change. Changing Part D plans can disrupt your health care routine. Many seniors don't want to risk upsetting their established method of getting medication and fear they could be even worse off with a new plan. Some seniors choose a Part D plan with the same insurance company that provided their employer-sponsored insurance before signing up for Medicare.
Access to specific pharmacies. Many retirees say it is important to them to have access to a pharmacy familiar to them or close to home. Some seniors also have a relationship with a specific pharmacist they don't want to give up.
The plan's brand name. A prescription drug plan's brand name matters to some Medicare beneficiaries. Retirees told KFF they felt reluctant to select a Part D plan from a company they had never heard of, even if that plan offered better benefits at a lower cost. Many retirees had both good and bad associations with large organizations, including AARP, Blue Cross Blue Shield, United Healthcare and Aetna, that influenced their plan choices.
Personal service. Many seniors said good customer service, especially in person, would make them more likely to choose a specific insurance provider, while poor customer service early on would make them more likely to switch. "Many seniors relied upon insurance agents to help them pick a plan, and the idea of having this in-person help was so appealing to seniors that oftentimes after the focus groups we would find that seniors were providing their insurance agent's contact information to other seniors that wanted it," says Gretchen Jacobson, associate director of the Program on Medicare Policy at the Kaiser Family Foundation.
Coordinating with a spouse. Married beneficiaries often prefer to have the same Part D plan or same insurer as their spouse. Retirees said it was more convenient to keep track of the rules for a single plan instead of two, even when separate plans might better cater to their individual health needs. "One woman in our focus group explained that it's much easier for her if her husband is in the same Part D plan because when she went to the pharmacy to pick up their medications she knew what her plan covered and how much it would cost for medications," Jacobson says. "She just could not imagine having two sets of rules for two different plans."
Star ratings. Medicare ranks its prescription drug plans based on quality, with five stars being the best possible rating. But most seniors admitted that they didn't know about the quality ratings. "Seniors said that their own experience with the plan was more important to them than the plan's quality rating," Jacobson says. You can check out the star ratings of plans in your area using Medicare.gov's plan finder tool.
Repetitive research. Many retirees spent a significant amount of time initially choosing a Medicare Part D plan, and they are reluctant to invest that much time again. Medicare beneficiaries said they would need to be significantly frustrated with their current plan in order to put in the effort to switch. "Seniors said that they found it very difficult to change plans and to choose plans," Jacobson says. "They liked having many options, but the process of choosing plans they found frustrating, confusing and exhausting."
Emily Brandon is the senior editor for Retirement at U.S. News. You can contact her on Twitter @aiming2retire, circle her on Google Plus or email her at firstname.lastname@example.org.