90 Percent of Those Enrolled in Medicare Prescription Drug Coverage Could be Overpaying, eHealth Analysis Shows
eHealth reports that shoppers at eHealthMedicare.com who compare
plans based on their personal prescription drug needs could have saved
an average of
The report finds that people using eHealth’s prescription drug coverage
comparison tool during the 2017 Annual Election Period (AEP) could have
saved an average of
Potential cost savings for switchers
The table below shows potential savings after calculating costs for
people who used eHealth’s
Potential average annual
Percent of users who could
Combined PDP and MA-PD
eHealth’s prescription drug comparison tool estimates the out-of-pocket
costs associated with prescription drug coverage under
In using the tool, consumers enter their zip code, the names and dosages
of their prescribed medications, and the name of their current
Savings with Medicare Advantage Prescription Drug (MA-PD) plans
- 87 percent of people shopping for MA-PD plans could have saved money by enrolling in a different plan, according to eHealth’s analysis of the prescription drug comparison tool’s results, which considers prescription drug regimens and plan options and other factors.
- Only 13 percent of MA-PD enrollees who used eHealth’s prescription drug coverage comparison tool during the study period were enrolled in the MA-PD plan providing optimal coverage for their prescription drugs, according to the data entered by the online users.
$807per year (or $67per month) was the average potential savings available to these consumers if they had enrolled in the optimal MA-PD plan for their personal prescription drug regimen, according to the prescription drug coverage comparison tool results.
Potential savings with stand-alone Medicare Prescription Drug Plans (PDPs or Part D plans)
- More than nine-in-ten (92 percent) could have potentially saved money by enrolling in a different PDP, according to eHealth’s analysis of the prescription drug comparison tool’s results, which considers prescription drug regimens and plan options and other factors.
- Only 8 percent of PDP enrollees who used eHealth’s prescription drug coverage comparison tool were currently enrolled in the PDP providing optimal coverage for their prescription drugs, according to the data entered by online users.
$486per year (or $41per month) was the average potential savings available to these consumers if they had enrolled in the optimal PDP for their personal prescription drug regimen, according to the prescription drug coverage comparison tool results.
Out-of-pocket costs for prescription drugs may change year to year
Changes to prescribed medications aside, the amount a
- The drugs covered by a plan
- The plan’s monthly premiums
- The plan’s annual deductible, coinsurance, and co-payments
- The plan’s drug tiers, which are used to assign different coinsurance amounts and co-payments to specific drugs
Any one of these changes may affect what an enrollee pays out of pocket
for his or her drugs on the same MA-PD or Part D plan from one year to
the next. In some cases, the lowest-cost plan for a
The actual savings estimated when a person uses the tool may differ based on variables such as geographic location, plan availability and selection, estimated full retail cost in each area, and other factors. Therefore, users of the tool can expect their actual realized savings to differ from the estimate provided by the tool for many reasons. For example, the estimates of full retail costs in each area may not reflect the actual prices available for drugs in a particular area. Benefits and coverage may also vary between plans. For instance, some plans may require step therapy (in which a patient must try a cheaper drug before trying a more expensive drug) or have other rules for drug coverage that may not be fully reflected in the prescription drug comparison tool’s results. When selecting a plan, consumers should always be sure to check the plan details to confirm the accuracy of any estimate of plan costs and coverage.
This report analyzes more than 30,000 user sessions that occurred on
eHealthMedicare.com and PlanPrescriber.com during the 2017 Annual
Election Period, which took place
The information users were required to provide in order to be counted as
currently enrolled in a PDP or MA-PD plan included their zip code and
the name of their existing PDP or MA-PD plan. In the user sessions used
for this analysis, customers also included the names, dosages and
frequency of any prescription drugs they were taking. Average annual
savings were calculated as the difference between the customer’s total
estimated out-of-pocket spending on their current plan — including
monthly premiums, deductibles, coinsurance, and co-payments — and the
total estimated out-of-pocket spending on the plan recommended by
For price comparisons, this study assumes no changes in prescription or
medical needs, as well as no changes in coverage rates or drug prices
during the applicable time period. The average savings presented in this
report are based on user sessions that occurred during the last AEP on
eHealthMedicare.com and PlanPrescriber.com only. These user sessions may
not reflect the overall
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