Up until now there has been general consensus that one doesn't need Medicare Part D prescription coverage since FEHB plans cover Rx so well.
Maybe not anymore?
The new law passed this year by Congress has some changes to Part D which could benefit FEHB enrollees as well.
For instance, starting in 2025, the out of pocket (oop) limit for Part D plans for Rx will be $2000. That is significant. While FEHB will probably still cover most Rx as good or better, this new oop limit could help in instances where someone on FEHB has Specialty Rx which normally wouldn't be fully covered until the much higher FEHB catastrophic yearly limit is reached--usually in the $5000 to $8500 range (although I believe NALC High has a separate $4000 Rx limit). For instance, I think the Specialty Rx cost for BCBS Focus, a very low-priced plan, is $350 per 30 day fill, which would be $4200 oop per year--but not if using a Part D plan?
In addition, for those who require insulin for diabetes, Part D plans are limited--starting this coming year in 2023--to a $35 per month copay WITHOUT having to pay a deductible first. I have not been able to verify which brand insulins, but apparently each plan has to offer some.
These are big changes which could help FEHB enrollees too? Although Part D would then become the primary Rx insurance, I think the FEHB would then act as secondary sort of like with Part B+FEHB medical claims now?
Hopefully the FEHB plans will voluntarily offer this lower oop for their own plans but I would be surprised if they do.
Any comments?
Maybe not anymore?
The new law passed this year by Congress has some changes to Part D which could benefit FEHB enrollees as well.
For instance, starting in 2025, the out of pocket (oop) limit for Part D plans for Rx will be $2000. That is significant. While FEHB will probably still cover most Rx as good or better, this new oop limit could help in instances where someone on FEHB has Specialty Rx which normally wouldn't be fully covered until the much higher FEHB catastrophic yearly limit is reached--usually in the $5000 to $8500 range (although I believe NALC High has a separate $4000 Rx limit). For instance, I think the Specialty Rx cost for BCBS Focus, a very low-priced plan, is $350 per 30 day fill, which would be $4200 oop per year--but not if using a Part D plan?
In addition, for those who require insulin for diabetes, Part D plans are limited--starting this coming year in 2023--to a $35 per month copay WITHOUT having to pay a deductible first. I have not been able to verify which brand insulins, but apparently each plan has to offer some.
These are big changes which could help FEHB enrollees too? Although Part D would then become the primary Rx insurance, I think the FEHB would then act as secondary sort of like with Part B+FEHB medical claims now?
Hopefully the FEHB plans will voluntarily offer this lower oop for their own plans but I would be surprised if they do.
Any comments?
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