Medicare Part D 2021 price increases

[audreyh1]

DH also signed up for the Aetna SmartRX Medicare Part D through Medicare.gov following the Boomer Benefits advice. Due to changes in the Medicare online state last year, Boomer Benefits is no longer able to use the Part D plan finder in a way that they can save drug and other information for their clients. The provide tutorials instead about how to use Medicare.gov yourself to evaluate plans during the open enrollment period.

 

[DektolMan]

Like many others here my Humana Walmart Value RX Part D premium is going up in 2021 from $13.20 to $17.20 per month. I'm switching to Aetna Silver Script SmartRx for $7.20 per month. Currently take zero prescriptions so this plan will work for me.

 

[lawman]

Like many others here my Humana Walmart Value RX Part D premium is going up in 2021 from $13.20 to $17.20 per month. I'm switching to Aetna Silver Script SmartRx for $7.20 per month. Currently take zero prescriptions so this plan will work for me.

My situation is yours exactly.. IT was a no brainer..
I switched today..

 

[CRLLS]

We were informed about a week ago that our Medicare part D pricing would remain the same in 2021 "BUT" to keep it we must convert to their Medicare Advantage program... (my previous employers retiree insurance program) Basically they want it all or nothing. And if you "opt out", all your dependents in the plan are also forced out and can never get back in.

There should be a law against "effectively" forcing you to their Medicare Advantage program.

I'm sorry to say, there is no law that guarantee's that your previous employer will continue any kind of retiree medical plan or assistance at all. It is happening all the time. The MC mantra of "the only thing constant is change" is unfortunately true even after you leave/retire.

 

[Telly]

........There should be a law against "effectively" forcing you to their Medicare Advantage program.

I'm sorry to say, there is no law that guarantee's that your previous employer will continue any kind of retiree medical plan or assistance at all. It is happening all the time. The MC mantra of "the only thing constant is change" is unfortunately true even after you leave/retire.

Yup!!!
And the consequences pre-ACA could be dire indeed! When I left megacorp years ago in the crash of an industry in the 2000-2002 recession, I was a bit miffed that I missed any retirement medical at all by little over a year. But no worry... megacorp killed all retiree medical starting the year after! Those who were 65 or older and retired had Medicare, they lost some $ help from the plan, but they could make it. But those <65 who had E-R'd, or Early E-R'd and had or developed health problems that would not pass underwriting were in big trouble! The only alternative insurance was private medical, to which pre-existing conditions were Kryptonite. An early-retired lady was in a battle with cancer. She moved out of the area ASAP to go live with her daughter up in her old home state, to save $ and try to survive somehow.

A few years ago, the state of Texas moved just about all retired teachers to a custom MA plan. Take it or leave it. Actually, it is the most unlike-an-MA-plan I've ever heard of, no networks, see anyone who accepts Medicare assignment, a $500 deductible, etc.. Unusual! The previous hodge-podge of retirement medical plans they had were too good to be true, tremendous money gobblers, came real close to disaster of a shut down.

In the past I've pointed this out to people I knew who bragged about their retiree medical plan. They mistakenly thought those benefits were set in stone. The biggest danger by far is to those <65, the Early Retirees. At least there is ACA now (?), but the premiums may be high. Still insurance, versus no insurance at all due to pre-existing conditions. I hope we do not go back to the dark ages. DW and I will be OK, we're >65, Medicare age now, but I do worry about all the others, and many here at E-R.org.

 

[Telly]

Back on the Part D 2021 price increases topic...

I'm a bit leery of a ~$7.50 premium Part D plan. How so cheap compared to everyone else? Not a little bit lower, a very large amount percentage-wise lower. A magical patented solution no others can use? Yeah, I'm a bit of a skeptic. Welcome to my parlor, said the spider to the fly...
Or a carnival barker hawking it.

I'm not trying to convince anyone out of it. We need test subjects! Also to see the longer-term effects (like y'all bailing out with singed feathers smoking at the 2022 Open Enrollment). Or saying what a wonderful world this has been.

 

[Sunset]

......
In the past I've pointed this out to people I knew who bragged about their retiree medical plan. They mistakenly thought those benefits were set in stone. The biggest danger by far is to those <65, the Early Retirees. At least there is ACA now (?), but the premiums may be high. Still insurance, versus no insurance at all due to pre-existing conditions. I hope we do not go back to the dark ages. .....

Funny, how I can hardly wait to get to the magic age of 65 before the rug is pulled out from under us.

 

[Car-Guy]

I'm sorry to say, there is no law that guarantee's that your previous employer will continue any kind of retiree medical plan or assistance at all. It is happening all the time.

It's the "implied" promises they break that p*** me off... I watched my employer pull some pretty s****y deals while I was employed by them for almost 30 years. It taught me pretty early they only really care about one thing... "And it ain't the employees". Between HR and the hundreds of company lawyers they can justify just about anything, "for the good of the company".

 

[Sue J]

I am also considering the Aetna SilverScript SmartRx for $7.50/mo.

I’m thinking that this is like a loss leader at a store. Get lots of new customers to sign on and then next year raise the price to a level closer to all the other Part D plans, like $15-$18 and hope the customers stay.

Early on, this plan was thought to have a very small formulary but looking at the actual formulary it’s got plenty in there. DHs nadolol is included at tier 2 and he would have to meet the deductible. He’s willing to just use GoodRx instead.

 

[harllee]

In my area the $7.50 Silverscript plan has a limited pharmacy network--CVS and one grocery store so check to make sure it includes a pharmacy you want to use. I decided not to go with Silverscript but take a slightly more expensive plan that I can use at my local pharmacy.

 

[audreyh1]

Back on the Part D 2021 price increases topic...

I'm a bit leery of a ~$7.50 premium Part D plan. How so cheap compared to everyone else? Not a little bit lower, a very large amount percentage-wise lower. A magical patented solution no others can use? Yeah, I'm a bit of a skeptic. Welcome to my parlor, said the spider to the fly...
Or a carnival barker hawking it.

I'm not trying to convince anyone out of it. We need test subjects! Also to see the longer-term effects (like y'all bailing out with singed feathers smoking at the 2022 Open Enrollment). Or saying what a wonderful world this has been.

I believe it’s simply targeted to those like DH who have no prescriptions and very rarely have a one-off inexpensive short prescription. Basically a placeholder to fulfill a requirement.

It’s only for 2021. Not concerned about singed feathers. We’ll see what is offered for 2022.

 

[audreyh1]

In my area the $7.50 Silverscript plan has a limited pharmacy network--CVS and one grocery store so check to make sure it includes a pharmacy you want to use. I decided not to go with Silverscript but take a slightly more expensive plan that I can use at my local pharmacy.

I noticed that they had a preferred and a standard pharmacy network, and the standard ones would cost just a little more.

In our case the preferred pharmacy options included ones we use already and even included Costco, so it was a good match.

 

[wenglish]

Need some help on the Medicare.gov Part D website for DH. He takes several prescription drugs and has entered them all on Medicare.gov and done a search for the best Part D plan for 2020. But many of the plans say "drug pricing information is not currently available". Is anyone else seeing this? Is the Medicare.gov site not up to date yet for 2020?

This is my first time trying to figure out Part D (for my wife), so I don't have an answer for you. But I do have an observation ...

I went through the tedious process of entering all her prescriptions via medicare.gov, then sorted the resulting list by total cost. I put the cheapest 12 or so into a spreadsheet, so I could sort them by price (one sort for retail, then sort for mail-order).

A few days later I realized that for any given plan, I could get details of the actual cost for up to 5 pharmacies. But 4 of the plans (namely those from Cigna and Express Scripts) are now showing "N/A" instead of the total cost numbers that I got a few days ago. So for those plans I can't get details of the total cost for each pharmacy.

I got the prices originally on 10/15 or 10/16. Could it be that they were 2020 prices for those 4 plans (even though I said I wanted 2021 prices)? Surely they should have shown "N/A" from the start, rather than displaying incorrect (presumably too low) prices.

How reliable is medicare.gov for this kind of decision? Can I expect the prescription prices to match what they said they would be over the whole of next year?

Any words of wisdom would be appreciated.

 

[harllee]

This is my first time trying to figure out Part D (for my wife), so I don't have an answer for you. But I do have an observation ...

I went through the tedious process of entering all her prescriptions via medicare.gov, then sorted the resulting list by total cost. I put the cheapest 12 or so into a spreadsheet, so I could sort them by price (one sort for retail, then sort for mail-order).

A few days later I realized that for any given plan, I could get details of the actual cost for up to 5 pharmacies. But 4 of the plans (namely those from Cigna and Express Scripts) are now showing "N/A" instead of the total cost numbers that I got a few days ago. So for those plans I can't get details of the total cost for each pharmacy.

I got the prices originally on 10/15 or 10/16. Could it be that they were 2020 prices for those 4 plans (even though I said I wanted 2021 prices)? Surely they should have shown "N/A" from the start, rather than displaying incorrect (presumably too low) prices.

How reliable is medicare.gov for this kind of decision? Can I expect the prescription prices to match what they said they would be over the whole of next year?

Any words of wisdom would be appreciated.

DH also keeps seeing "N/A" on drug prices for Cigna plans on Medicare.gov. He has tried to call Cigna but can never get through on the phone so he said he will eliminate that company from consideration. As for reliability of the Medicare.gov site I would like to know the answer to that question also. If the Medicare.gov site shows a price for a drug is the insurance company obligated to cover the drug for that price?

 

[MBSC]

A few days later I realized that for any given plan, I could get details of the actual cost for up to 5 pharmacies. But 4 of the plans (namely those from Cigna and Express Scripts) are now showing "N/A" instead of the total cost numbers that I got a few days ago. So for those plans I can't get details of the total cost for each pharmacy.

I got the prices originally on 10/15 or 10/16. Could it be that they were 2020 prices for those 4 plans (even though I said I wanted 2021 prices)? Surely they should have shown "N/A" from the start, rather than displaying incorrect (presumably too low) prices.

Cigna sent this email to brokers on Saturday. Quirks like this seem to happen each year so I've started advising those taking prescriptions to wait until November.

"Dear Valued Broker,

We’ve identified an issue with our 2021 prescription drug plans’ (PDP) pricing posted on CMS’ Plan Finder tool (Medicare.gov). The drug pricing posted for our three Cigna and three Express Scripts PDPs is incorrect. While consumers will be able to enroll, neither you nor your customers will be able to fully evaluate 2021 PDP pricing using CMS’ Plan Finder tool (Medicare.gov).

This does NOT impact our MAPD plans for 2021.

We are working diligently to correct the issue and expect to have the pricing corrected on Medicare.gov no later than October 26th. We suggest that you revisit the site on the date listed."

Can I expect the prescription prices to match what they said they would be over the whole of next year?

See below.

Why do the costs I pay for my drugs change throughout the year?
...There are times when the manufacturer increases the cost of a drug. If you are paying a percentage of that cost, then when the cost increases, both you and your plan will be paying more for the drug.

Source: https://www.silverscript.com/faq/why-do-the-costs-i-pay-for-my-drugs-change-throughout-the-year

 

[harllee]

My DH has been on the phone about an hour with Cigna (on hold at least 30 minutes) trying to figure out why Medicare.gov does not show his drug prices for Cigna. He could never get a straight answer. He is currently with Cigna but he is giving up on them and will go with another company, after all he has 31 choices on Medicare.gov!

 

[REWahoo]

My DH has been on the phone about an hour with Cigna (on hold at least 30 minutes) trying to figure out why Medicare.gov does not show his drug prices for Cigna. He could never get a straight answer. He is currently with Cigna but he is giving up on them and will go with another company, after all he has 31 choices on Medicare.gov!

What's the rush, you have until Dec 7 to make a change, right? See MBSC's post above and wait a couple of weeks for them to correct the website.

 

[wenglish]

Cigna sent this email to brokers on Saturday. Quirks like this seem to happen each year so I've started advising those taking prescriptions to wait until November.

"Dear Valued Broker,

We’ve identified an issue with our 2021 prescription drug plans’ (PDP) pricing posted on CMS’ Plan Finder tool (Medicare.gov). The drug pricing posted for our three Cigna and three Express Scripts PDPs is incorrect. While consumers will be able to enroll, neither you nor your customers will be able to fully evaluate 2021 PDP pricing using CMS’ Plan Finder tool (Medicare.gov).

This does NOT impact our MAPD plans for 2021.

We are working diligently to correct the issue and expect to have the pricing corrected on Medicare.gov no later than October 26th. We suggest that you revisit the site on the date listed."

Thanks MSBC. I will cool my heels for a bit.

I'm stressed because her "membership" in part B (to start 1/1/2021) isn't showing up on medicare.gov yet, and I don't want to run out of time to get her set up for Part B, then Part D, and then Medigap before their respective deadlines (she's in a special enrollment period so the regular deadlines may not apply). I just want to get this done and onto the next major stressors - open enrollment for my workplace health insurance, and of course taxes

 

[harllee]

What's the rush, you have until Dec 7 to make a change, right? See MBSC's post above and wait a couple of weeks for them to correct the website.

No particular rush (although I would not recommend waiting until the last minute to make the change) but after talking to the clueless and somewhat rude Cigna employee on the phone this morning DH decided to find a more competent company to deal with. DH takes several prescriptions so he likes to take his time and compare all the plans available to him on Medicare.gov. This year there are 31 plans (less 3 from Cigna that do not show the drug info). It will take him a week or two to make a final decision.

 

[Accidental Retiree]

Like many others here my Humana Walmart Value RX Part D premium is going up in 2021 from $13.20 to $17.20 per month. I'm switching to Aetna Silver Script SmartRx for $7.20 per month. Currently take zero prescriptions so this plan will work for me.

Same here.

 

[REWahoo]

Looks like the missing information on the Medicare.gov "Plan Finder" site has been corrected. I went in this morning and chose a new Plan D provider for DW and for me. I went with different insurers as she takes daily prescription meds and I don't, so I simply chose the plan with the cheapest monthly premium. Took about 30 minutes to do both, and almost half of that time was inputting her prescriptions and verifying her drug costs.

This is the first time since we went on Medicare that we've had separate Part D providers but I couldn't see paying an additional $125 a year in premiums simply for consistency.

 

[youbet]

Like many others here my Humana Walmart Value RX Part D premium is going up in 2021 from $13.20 to $17.20 per month. I'm switching to Aetna Silver Script SmartRx for $7.20 per month. Currently take zero prescriptions so this plan will work for me.

It does seem like for folks not taking any prescription meds, and not planning to in 2021, going with the lowest premium is the smart choice. In my case, since I take several meds (one very expensive), it turns out that the lowest premium plan is not the lowest overall annual cost for me.

It looks like I'll be switching away from Humana Walmart Value Rx plan to something else. Several offer a lower projected total annual cost for me for 2021 but not because the premiums are lower, rather because the copay for my expensive drug is lower.

It is a headache figuring out which plan works best each year and then getting your prescriptions transferred, etc.

 

[kaneohe]

Just a reminder that in addition to mo. premium and cost of drugs, another useful thing to look for is to be sure that you can live w/ any restrictions that may exist. This is found in the detail for each plan near the bottom. My current plan Humana Walmart Value plan in addition to being more expensive for premium and drugs next yr, also has quantity restrictions on several drugs (that I can live with) but a required pre-approval on 1 drug that I don't want to deal with.

The new plan I am looking at will be cheaper and not have those restrictions.

 

[wenglish]

Thanks for the reminder kaneohe. I re-checked the plan I chose for my wife, and while it doesn't require prior authorization for any of her prescriptions, it does have quantity limits on a couple (60 vs. 90 and 30 vs. 60). In cases like that, does the pharmacy charge you full retail for the excess amount, or can you not get the extra (required but not covered) quantity?

 

[PaunchyPirate]

Thanks for the reminder kaneohe. I re-checked the plan I chose for my wife, and while it doesn't require prior authorization for any of her prescriptions, it does have quantity limits on a couple (60 vs. 90 and 30 vs. 60). In cases like that, does the pharmacy charge you full retail for the excess amount, or can you not get the extra (required but not covered) quantity?

You can always get the additional quantity if your doctor prescribes that quantity (using insurance is not mandatory). But it would be up to you to pay for the additional quantity. If the situation applies to you, I would ask you Dr. or Pharmacist to split it into 2 prescriptions (not sure who would have to do it) and attempt to use something like GoodRx for better pricing on the part your insurance will not cover. Depending on the drug, you may also get discounted pricing directly from the manufacturer. Don't just pay for it without looking into your options. Also, retail prices vary from pharmacy to pharmacy. Call around for best pricing.