Outsmart the System: How to Navigate Pharmacy Closures and Surprise Medical Bills

Tips and tricks to get your prescriptions easily and avoid unexpected expenses

Sari Harrar,

AARP

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Published December 11, 2024

Kiersten Essenpreis

Our world has become more digital, virtual and automated. Still, the post-pandemic economy can at times feel unstable. How do we navigate this new landscape and make the system work for us?

As part of a year-end series, AARP gathered professional guidance on a number of topics to help you outsmart the system. Today’s topic: Health care.

Pharmacy closures

Drugstores are closing retail locations. What options do I have?

Between 2019 and the first half of 2024, more than 7,000 chain and independent drugstores closed in the U.S., according to a University of Pittsburgh study. CVS and Rite Aid have been closing hundreds of stores, and Walgreens announced plans for about 1,200 closures over the next three years. In addition, according to a February 2024 survey, a third of independent drugstore owners said they may also shut their doors before year’s end.

Here are three options to pursue if you need your prescriptions filled.

1. Don’t limit yourself to a single pharmacy choice. If you can, sign up for a health plan that gives you more pharmacy options, advises Dima Qato, an associate professor at the University of Southern California Mann School of Pharmacy and lead researcher for the 2019 study. If you’re on Medicare and need more options, you can switch your Part D drug coverage during the next open enrollment period, starting in October 2025. “People tend to be as loyal to their pharmacist as they are their physicians,” says Ray Walker, divisional director for the Medicare Assistance Program at the Oklahoma Insurance Department. “But if that preferred pharmacy isn’t going to be there in six months, it could create hardship.”

2. Request a special Medicare enrollment period. If your pharmacy closes and the next closest in your plan is miles away, you might not be able to wait to get on a new plan, Walker says. “If a person finds themselves in this situation, they can contact 1-800-Medicare (1-800-633-4227) and request an ‘exceptional circumstance’ special enrollment period (SEP) to switch to a different plan.”

3. Order by mail. This can be especially helpful for drugs that you take regularly, since they get delivered to your doorstep. Look for a mail-order or online pharmacy covered by your health plan, says Elvin T. Price, director of the Geriatric Pharmacotherapy Program at Virginia Commonwealth University.

Unexpected medical bills

Where did these charges come from? Can I avoid surprise billing?

Forty-three percent of American adults have received at least one problem medical bill in the previous five years, according to a 2022 national survey by KFF, a nonprofit health policy research group. Billing troubles can be overcharges or invoices for services not received, already paid for, thought were covered by health insurance or those you just can’t afford.

Problem bills are a big reason why 5.1 million older adults have medical debt that’s gone to a collection agency, according to the Consumer Financial Protection Bureau.

Here are five ways you can avoid surprise billing.

1. Speak up. About three-quarters of adults who challenged a mistake or unaffordable bill got help, according to an August 2024 University of Southern California survey. The results include bill corrections, payment plans, financial assistance, a price cut or bill cancellation.

2. Ask for an estimate. Before an elective procedure or a long-term or potentially expensive treatment, get an estimate of the charges, says medical billing specialist Martine Brousse, owner of AdvimedPro in Culver City, California. “An estimate is not a final bill, but it can help you plan ahead.”

3. Don’t pay right away. That first bill you get, say 15 to 30 days after a medical visit, may not have been processed by your health insurer yet, and so it may not reflect what you owe after insurance pays, Brousse says. “You shouldn’t pay a bill until after you see a final explanation of benefits from your insurance company or Medicare,” she says. If you overpay an early bill, you can get a refund, but it can be time-consuming.

4. Compare the bill to insurance coverage. “The explanation of benefits will tell you whether a medical bill was processed correctly,” says Jenni Nolan, an independent patient financial advocate and owner of Clear Healthcare Advocacy in Carmel, Indiana. Common discrepancies that deserve a call to your provider include duplicate charges, coding errors, in-network charges billed at an out-of-network rate, denied services and bills never sent to your insurer.

5. Challenge surprise ambulance fees. Consumers typically have no say over whether the EMT crew that responds to a call is in their network. This gap costs Americans $129 million a year, according to a 2020 study.

“These bills can be thousands of dollars,” Nolan says. Don’t automatically pay that inflated, out-of-network ambulance bill. Instead, Nolan suggests, negotiate a lower rate based on published Medicare coverage rates for your area, which you can find here. A standard offer is double the Medicare rate.

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