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Medicare Part D Website is Open Early for AEP!

There is some great news for Medicare beneficiaries. The Medicare website that allows you to compare Part D Drug plans, as well as supplemental coverage, is up and running for a “sneak peek: www.medicare.gov”. Historically it did not go live until the first day of open enrollment. Star ratings for the plan are not yet updated.

The Medicare Open Enrollment Period runs from October 15 to December 7 each year. New choices are effective January 1, 2024. During this time Medicare beneficiaries may:

• Join, drop, or switch to another Medicare Advantage Plan (or add or drop drug coverage).

• Switch from Original Medicare to a Medicare Advantage Plan.

• Join a Medicare Part D drug plan or change drug plans, if enrolled in Original Medicare.

By now beneficiaries have received the Annual Notice of Change, explaining the changes to their existing plans. For example, my husband’s Silver Script Plan with Aetna which covers Eliquis, increased premium to $116 from $69.10 and now has a deductible of $200 vs none.

If he were to stay on that plan and Eliquis his only Rx, using CVS, Safeway, or Walgreens; his total cost for the year including deductible, premium, and copays would be almost $2500.

If he were to change to Clear Spring Value Rx It would be about $1600, a savings of almost $900!

If he were to stay with Silver Script and use the “Smart Saver Plan” the cost would be just over $2000 at CVS or Safeway, but $8136 if he used Walgreens, an out-of-network pharmacy.
The monthly premium for the “Smart Saver Plan” is $18.60. Clear Springs has historically had only a 1.5-star rating.  Wellcare Value Plus has had a higher star rating and a total cost of $1754 if using Safeway.

If he were to buy no drug coverage and purchase the drugs through Canadian Pharmacy World with the drug manufactured in Canada, the annual cost would be $1828 per year. If he chose to have his drugs manufactured in Turkey and purchased through this company, the annual cost would be $716.

If you are taking no medications and simply want a placeholder plan that will help you avoid the penalty for late enrollment and cover some cheap generics, the Wellcare Value plan monthly premium is $0.40 monthly. That is not a typo, yes, $0.40.

The lesson here is that you must be attentive to your coverage! Shopping your plans will always benefit you even if you don’t make any changes.

Medicare designs the basic level of drug benefits and all the plans must have benefits at least as good as this basic design. In 2024, there are 4 phases and the individuals’ share of costs are:

1: Deductible: $545 annual deductible.

2-3: Initial Coverage and Gap: Copays or coinsurance cost sharing of about 25%:

4: Catastrophic: Once the individual has paid about $3300 out of pocket for covered drugs, the plan will pay 100%. This change was part of the Inflation Reduction Act of 2022.

Those taking some of the highest-cost cancer medicines like Pomalyst or Revlimid, will save around $10,000 per year due to this increased catastrophic benefit. Note, that these drugs are not covered under the Clear Spring Plan.

The key phrase here is “covered drugs”. While each plan generally must cover two drugs in each category, that does not mean that your particular drug is covered on the plan. We are all one doctor visit away from a new medication, so there is an element of the unknown. Once you are covered, bring your formulary to your appointments so you can help your physician find a drug that is on your plan.

If the Rx is not covered, you can ask the manufacturer for help or wait until the following year to change plans.

Medicare Advantage (MA) Plans are a bit more complicated. Simply, Medicare Advantage is where an individual gives up Original Medicare and takes the insurance company plan. It may or may not include drug coverage. It may function like an HMO requiring a closed panel of providers or a PPO plan that restricts the panel of providers and provides reduced benefits if one goes out of network.

One can join an MA plan or switch plans during this open enrollment period. If they want to drop Medicare Advantage and go back to Original Medicare, that open enrollment period is January 1-March 31.

Being very careful about enrolling in a Medicare Advantage Plan is important. First, check the participating providers, then call your provider to verify that they really do accept the plan. In the HMO options typically you are not covered for expenses out of the network. This may be fine with your primary care doctor, but specialists can be very expensive.

Also, if you join a Medicare Advantage Plan and decide you don’t like it, you are only guaranteed the option to buy a Medicare Supplement if you drop the Advantage plan in the first year.  Otherwise, you must qualify for the plan by answering health questions and can be turned down. Again, be very cautious.

If you are not working with an agent and are intimidated by the Medicare website, you may phone HICAPP (Health Insurance Counseling & Advocacy Program) at 530-223-0999. Call soon as they fill up fast!

If you appreciate Margaret R. Beck’s informational columns, please consider a contribution to A News Cafe. Thank you.

 

 

 

Margaret R. Beck

Margaret Beck CLU, ChFC, CEBS started her insurance practice in Redding in 1978. She founded Affiliated Benefit Services.

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