Why does my Medicare plan charge me more for my medication?

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil; and he will answer as many as he can.

Nancy – Ind.: My husband was just prescribed a new medication. We had it sent to the preferred pharmacy of our Part D insured. They called us to get permission to charge us $210 for a 90-day supply. I said, “No thanks,” and got it filled at our local pharmacy for $81. Why do I need Part D and the monthly premium I’m paying if this is what I wind up paying for drugs?

Phil Moeller: I get lots of Medicare prescription-drug horror stories. Before walking away from your Part D plan, however, I’d urge you to shop for a better one during this fall’s open enrollment period, which begins Oct. 15. Hopefully, you can find a plan that charges you less for the drugs you take. Also, if your husband doesn’t take a lot of drugs, it’s possible he hadn’t yet reached the plan’s annual deductible yet, and thus was being charged full price for this medication.

It’s often possible to find individual drugs that cost less than what you’d pay in a Part D plan. I’d just keep in mind that insurance is for things you can’t control. In the area of drugs, this would include the unexpected need for a very expensive drug. If this need occurred and you had no insurance, would you be able to afford paying six figures a year for one of these new wonder drugs?

If you can’t get any better prices on your medications from a Part D plan in 2019, I’d suggest you look for the plan with the lowest premium. This would reduce your out-of-pocket spending while still protecting you from having to pay full price for very expensive medications should you ever need them.

James – Calif.: My wife learned several years ago that Social Security paid her too much in benefits when her dad died. This was way back in 1979! She was 16 at that time and never cashed the check or saw the money. And I hadn’t even met her yet! But Social Security held back my 2014 tax refund to the tune of $2,000 dollars. The agency has refused to answer our questions. We asked our Congressman’s office to look into it. They at first thought it was a scam but later reported there was nothing they could do about it. I left things there, but now, in 2018, I was due another tax refund and Social Security took still more money away from me. Help!

Phil Moeller: This is horrible. Unless the agency is making things up (which in my experience it does not do), I am guessing that her mom received your wife’s child survivor benefit and spent the money. After the death of her husband, she may have needed every penny.

Even if the agency is technically correct, however, I am appalled that it would go after her (and thus you) nearly 40 years after these payments were made. And while having your tax refunds garnished is awful, it at least provides documentation that this is an official Social Security action and not a scam.

Somewhere, Social Security should have sent you correspondence with details on what it was doing. If not, you certainly have a right to request a formal explanation for its ruling. You also have the right to appeal what it has done.

I wish I had a better response. Social Security does make mistakes and it’s hard to hold the agency to account for them. All I can say is that you need to keep at it. In my experience, nearly all Social Security employees want to do the right thing. Please let me know how things turn out.

Ned – Nevada: I recently moved to Nevada from California and am on original Medicare. I would rather use Kaiser in California, which is what I had been using most of my life. But Kaiser only accepts Medicare Advantage, not original Medicare. I live near the California border and it would be easy for me to continue using Kaiser. I’ve instructed Medicare to switch my mailing address to my relative’s address in California while maintaining my residential address in Nevada. Does that make a difference as to where I can shop for a Medicare Advantage plan?

Phil Moeller: If your legal residence is in Nevada, Medicare rules say you would need to find a Medicare Advantage plan that covered your home market. I am told that a mailing address does not satisfy residency requirements and that care provided outside your plan area might not be covered by your plan. I’d suggest you speak with folks at the Kaiser California location and see if they can suggest a workable solution. Please let me know what they say.

Dawn – Mass.: I turned 62 in 2017; my husband reached his full retirement age of 66 earlier this year. At a retirement sales seminar, I was told that my husband could file a restricted application to defer his benefits, allowing me to take a spousal benefit now and later switch to my own retirement benefit. I thought I had missed out on this since I turned 62 after the most recent change to Social Security laws, but the rep insisted I can do this. What’s the story here?

Phil Moeller: From what you say, I believe the rep was incorrect.

Changes passed in 2015 ended the ability of your husband to file and suspend his own benefit, which would have enabled you to file for a spousal benefit as the rep said. If your husband instead filed for his own benefit, you would have been able under the old rules to file a restricted application for just your spousal benefit, while deferring your own retirement filing until later. However, under terms of the 2015 law, you are too young to be eligible to file such a restricted application.