Part D Drug Plan questions - Not using drugs; switching plans risk-free?

[Telly]

Continuing my research of Medicare, Medigap, and Part D Drug Plan for implementation later this year. Neither the Medicare website, nor their 136 page Medicare Handbook give any insight on:

1.) How do you pick a particular Part D plan, if you are NOT on any prescription medications? The only prescriptions I ever had were for antibiotics, or for pain killers after surgery, all were very short-term use. So my present "formulary" requirements are zero! But it seems I should assume this will change, someday.
I could just select a cheap Walgreens or Walmart plan based on my zero usage, and have some coverage. Otherwise, to do more, am I doomed to think up what drugs older folks MIGHT use, and check to see if they are all covered in a plan's formulary? Seems a big task, and where would one stop?

2.) Once a person is on a Part D Drug Plan, when the next year rolls around, is there any cost/insurability risk with changing to another plan? What I am asking is, is there any pre-existing condition type of clause? Could one start with a cheaper low-coverage plan, and if later after being diagnosed with something big and $$$, switch to a wider or super-coverage plan? I could not find any mention about it.

 

[omni550]

Continuing my research of Medicare, Medigap, and Part D Drug Plan for implementation later this year. Neither the Medicare website, nor their 136 page Medicare Handbook give any insight on:

1.) How do you pick a particular Part D plan, if you are NOT on any prescription medications? The only prescriptions I ever had were for antibiotics, or for pain killers after surgery, all were very short-term use. So my present "formulary" requirements are zero! But it seems I should assume this will change, someday.
I could just select a cheap Walgreens or Walmart plan based on my zero usage, and have some coverage. Otherwise, to do more, am I doomed to think up what drugs older folks MIGHT use, and check to see if they are all covered in a plan's formulary? Seems a big task, and where would one stop?

2.) Once a person is on a Part D Drug Plan, when the next year rolls around, is there any cost/insurability risk with changing to another plan? What I am asking is, is there any pre-existing condition type of clause? Could one start with a cheaper low-coverage plan, and if later after being diagnosed with something big and $$$, switch to a wider or super-coverage plan? I could not find any mention about it.

Telly,

Like you, I am not on any ongoing prescription medications.

I have opted for the least expensive Plan D that was available to me. The first 2 years I was on Humana-WalMart, and this year I switched to Envision Rx. There was no issue with switching insurers.

I've had a few random Rx's in 3 years. For example: for a cruise, I needed Transderm Scop for anti-seasickness. Another time, I had a severe, prolonged cough, and was prescribed a 10-day course of antibiotics. I recall that for one Rx, I actually got a larger discount from one of those free cards (like GoodRx, etc.) that you stumble across that is supposed to get you Rx discounts than I did from my Part D provider. YMMV.

If and when I need ongoing Rxs, I will shop the formularies for whichever insurer offers the most coverage for what I need.

I am interested in getting the Shingrx vaccine. At the moment, neither Medicare ( which would pay for 80% & the remaining 20% paid by my Part G Aetna) nor Part D (Envision Rx) plans cover it. I may wait a few months to see if Shingrx is added to the Envision Rx formulary or if Medicare/Aetna finally covers it....or I can wait unit the fall and see if there's another inexpensive Part D plan that has Shingrx in its formulary or I may just shop around for the least expensive Shingrx I can find locally (in the US or nearby Canada) and pay out of pocket.

omni

 

[kaneohe]

..........................................

2.) Once a person is on a Part D Drug Plan, when the next year rolls around, is there any cost/insurability risk with changing to another plan? What I am asking is, is there any pre-existing condition type of clause? Could one start with a cheaper low-coverage plan, and if later after being diagnosed with something big and $$$, switch to a wider or super-coverage plan? I could not find any mention about it.

You can do it during open enrollment period each yr so there may be a partial yr when you get stuck w/ non-optimum benefits. This link doesn't mention pre-existing conditions either but in my mind, that's the basic definition of open enrollment..........that anyone can change w/o a problem.
https://www.medicare.gov/sign-up-ch...join-a-health-or-drug-plan.html#collapse-3190

 

[Telly]

Thanks for all your info in the post, omni! So, finally, there is something in Medicare that I don't have to worry about switching! Woo-Hoo!

.......I have opted for the least expensive Plan D that was available to me. The first 2 years I was on Humana-WalMart, and this year I switched to Envision Rx. There was no issue with switching insurers........

I do have a question with regards to the snippet above... May I ask what was your motivation for switching? Coverage, cost, service, other?

From kaneohe:

You can do it during open enrollment period each yr so there may be a partial yr when you get stuck w/ non-optimum benefits. This link doesn't mention pre-existing conditions either but in my mind, that's the basic definition of open enrollment..........that anyone can change w/o a problem.
https://www.medicare.gov/sign-up-cha...#collapse-3190

I've gotten a bit shy of reading Medicare documents, and assuming anything that is not specifically stated there! Like the "open enrollment" for Medigap Plans. After the initial acceptance guaranteed period, they did not come right out and say that changing Medigap plans may cause one to be subjected to underwriting!

 

[omni550]

Thanks for all your info in the post, omni! So, finally, there is something in Medicare that I don't have to worry about switching! Woo-Hoo!

I do have a question with regards to the snippet above... May I ask what was your motivation for switching? Coverage, cost, service, other?

YW.

I switched because of cost and curiosity about how the switch would work.

Someone posted about Envision Rx here. I noticed it was a bit less expensive than the Humana-Walmart plan I was on. As I am not getting much use out of my Part D (it's more of a placeholder so I do not incur large surcharges down the road when I might need Plan D for ongoing Rxs), I thought I'd check it out.

omni

 

[CRLLS]

Yesterday I had my 1st opportunity to use a Medicare Part D drug plan, the Walmart-Humana plan. Dr. prescribed 2 different pain relievers. I had no previous drug claims. My total out of pocket for both prescriptions was $0.67. No deductible was applied as they were both Tier 1 drugs which require no deductible. I'm not sure if all Part D plans allow their Tier 1 and/or Tier 2 to be covered with no deductible?

 

[grasshopper]

I have the $20.40 a month WalMart/Humana plan. I have a lifetime thyroid drug that is Tier 1 I use the ship to home no cost to me plan. Now of course paying $20.40 a month for the same drug I got at WM for $4 a month, hmmmm

 

[mn54]

YW.

I switched because of cost and curiosity about how the switch would work.

Someone posted about Envision Rx here. I noticed it was a bit less expensive than the Humana-Walmart plan I was on. As I am not getting much use out of my Part D (it's more of a placeholder so I do not incur large surcharges down the road when I might need Plan D for ongoing Rxs), I thought I'd check it out.

omni

If you do not get part D when you first enroll and down the road need to get it how large a surcharge are we talking about?

 

[travelover]

..........
I am interested in getting the Shingrx vaccine. At the moment, neither Medicare ( which would pay for 80% & the remaining 20% paid by my Part G Aetna) nor Part D (Envision Rx) plans cover it. I may wait a few months to see if Shingrx is added to the Envision Rx formulary or if Medicare/Aetna finally covers it....or I can wait unit the fall and see if there's another inexpensive Part D plan that has Shingrx in its formulary or I may just shop around for the least expensive Shingrx I can find locally (in the US or nearby Canada) and pay out of pocket.

omni

Same boat - I have Envision for my part D, too. I decided to pop for it out of pocket - $150-ish at Costco for each shot. With my luck, I'd wait and get shingles and kick myself for waiting.

 

[omni550]

If you do not get part D when you first enroll and down the road need to get it how large a surcharge are we talking about?

Let me google that for you...

https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html

omni