Wow, Just got the renewal notice on Plan D

[ivinsfan]

I'm going to be curious if advantage plans go up since part d coverage is included in the premium.

 

[grayv]

I'm going to be curious if advantage plans go up since part d coverage is included in the premium.

They might stay the same, by increasing drug copays and max-out-of-pockets.

 

[trumpeting_angel]

Silverscript

Also in WA state, and just got notification from Silverscripts of 2020 rates--actually down about a $1.20 but they added a $245 deductible but did reduce in prices for Tier 1 & 2, raised in Tier 4 and reduced in Tier 5. So like all Plan D, the devil in your personal details.
Other insurer pricing does not yet seem available

Just received my Silverscript tomes also, with the same numbers. I need a software engineer to help me figure out what my costs will likely/could possibly be. And I have to get my hands on a formulary, and try to guess which statin I’m likely to be prescribed now that my test results are in.

When you sit back and look at the whole picture, the US healthcare system is a ridiculous maze of options for different ages, employment statuses, incomes, and health statuses, which is very difficult to make any sense of. I’m a recently retired healthcare professional with plenty of experience with health insurance plans, but nevertheless I needed assistance to enroll because of an extremely minor detail related to the date my employer coverage ending vs. the date I was leaving the job. That was only a few months ago and now I’m looking at complex calculations just to choose Part D for next year.

Sigh. Ready for Single Payer.

 

[Amethyst]

Or limits on the amount of medication you can get; that's how our BCBS plan keeps costs down. Need more? Out of pocket.

 

[MBSC]

Starting in 2020, Part D plans will have the option of saying a drug is on-formulary when treating certain conditions but off-formulary for other conditions.

For example, a tumor necrosis factor blocker that’s FDA-approved to treat both Crohn’s disease and plaque psoriasis could be included on the formulary only for plaque psoriasis, so long as a similar drug on the formulary is covered for Crohn’s disease.

Source: https://www.kiplinger.com/article/r...te-2020-medicare-changes-open-enrollment.html

"It makes a lot of sense to borrow some of the tools that are used in commercial plans," said Marsha Simon, PhD, president of Simon & Co., a firm specializing in health policy development.

But she warned that allowing plans to exclude certain drugs for certain indications could make formularies too complex and sow confusion for beneficiaries.

"There's no question that adding this additional option for plans makes the program even more complex and even more difficult to understand and more likely to result in a doctor prescribing a drug that's not going to be on the formulary."

The American College of Rheumatology also expressed concern. "Unlike step therapy, which often delays effective treatments, this would go even further and allow plans to remove therapies from the formulary altogether, leaving patients completely unable to access treatments that doctors and patients choose together."

Source: https://www.healthleadersmedia.com/...ow-indication-based-formulary-design-medicare

CMS announced additional flexibilities in the Medicare Part D program to allow for innovative formulary design as a valuable approach to expand drug choices and address the challenge of high drug costs for seniors.
Part D plan sponsors will have the choice of implementing indication-based formulary design beginning in CY 2020. This new guidance expands upon our existing policy by allowing Medicare Part D plan sponsors to tailor which drugs are on their formulary by specific indications.

What is Indication-Based Formulary Design?
Indication-based formulary design is a formulary management tool that allows health plans to tailor on-formulary coverage of drugs predicated on specific indications. Under this type of formulary design, health plans have the ability to negotiate formulary coverage based on specific indications.

How is this Different from Existing Policy?
Existing CMS policy requires that if a Part D plan includes a particular drug on its formulary, the plan must cover that drug for every indication approved by the U.S. Food & Drug Administration, except for those uses that are statutorily excluded from Part D coverage, even if the plan would otherwise instead cover a different drug for a particular indication.

To ensure Medicare beneficiaries are able to make informed enrollment decisions based on information available within the Medicare Plan Finder (MPF), the application of indication based management to a drug will be included in MPF for display under the drug coverage information section.

In addition, Medicare & You will be updated to help educate beneficiaries that formulary coverage may also depend on the disease state, or indication, for which the drug is being prescribed.

Source: https://www.cms.gov/newsroom/fact-s...mulary-design-beginning-contract-year-cy-2020

 

[MBSC]

I volunteer for Part D plan review. We use the Medicare website that is an excellent tool for comparing plans.

Some consumer advocacy groups are not fans of the new Medicare Plan Finder tool. The new design, still showing 2019 plans, can be found here: https://www.medicare.gov/blog/try-our-new-and-improved-medicare-plan-finder

Justice in Aging, Medicare Rights Center, Center for Medicare Advocacy and the National Council on Aging recently sent a joint letter to Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), urging the agency to address concerns regarding changes to the Medicare Plan Finder (MPF) tool and the 2020 Medicare Communications and Marketing Guidance (MCMG).

Source: https://blog.medicarerights.org/ben...der-and-revision-of-medicare-marketing-rules/

In the current or Legacy Plan Finder, some users find it difficult to view preferred pharmacies, those that offer preferred retail cost sharing. That won’t be a problem with the new Plan Finder. It doesn’t include preferred pharmacies.

As for interpreting how much they will pay for drug coverage, the new Plan Finder does not include an estimate of total costs for the year.

CMS is giving everyone who does plan reviews just one month to test the system. And, this isn’t just any month. It’s the month before the biggest plan review time of the year, Open Enrollment. No more practicing then.

Source: https://www.forbes.com/sites/dianeo...r-doesnt-fix-the-woes-gao-found/#6a09564a2638

 

[John Galt III]

I'm going to be curious if advantage plans go up since part d coverage is included in the premium.

Seems like the 'Get a supplement and Part D and you will be stress-free' mantra is being tarnished somewhat lately. First it was someone saying a blood test was not covered by her supplement plan, now this Part D stuff. Making Medicare Advantage plans look less awful than before, lol.

 

[ivinsfan]

Seems like the 'Get a supplement and Part D and you will be stress-free' mantra is being tarnished somewhat lately. First it was someone saying a blood test was not covered by her supplement plan, now this Part D stuff. Making Medicare Advantage plans look less awful than before, lol.

Get back to us on that after you actually use your Advantage plan for treatment and medication.
I hope it work out for you..you'll find the Advantage drugs plans have plenty of issues too.

 

[John Galt III]

Get back to us on that after you actually use your Advantage plan for treatment and medication.
I hope it work out for you..you'll find the Advantage drugs plans have plenty of issues too.

Well, I hope I don't have to use my MA plan for anything major, since it does have significant copays, like $300 for an MRI. I have used it so far for a blood test ($15 copay) and for a dental checkup (2 xrays, cleaning and oral exam) for $10 copay, and no glitches have surfaced.

 

[ivinsfan]

Well, I hope I don't have to use my MA plan for anything major, since it does have significant copays, like $300 for an MRI. I have used it so far for a blood test ($15 copay) and for a dental checkup (2 xrays, cleaning and oral exam) for $10 copay, and no glitches have surfaced.

I hope you don't either wishing you nothing but good health,,

 

[aja8888]

Well, I hope I don't have to use my MA plan for anything major, since it does have significant copays, like $300 for an MRI. I have used it so far for a blood test ($15 copay) and for a dental checkup (2 xrays, cleaning and oral exam) for $10 copay, and no glitches have surfaced.

Yes, but in our experience, it's not about the small amount of copays, it's really about having the ability to choose your specialist when the need arises.

 

[Animorph]

This thread scared me until I finally got my 2020 plan info. My Cigna Plan D goes from $29.90 to $30.60. I don't see any operational changes that affect me. There's even a new tier with free drugs, though not mine. So I'm happy with my selection for this year.

My ACA plan is even returning $2500 for overcharging in 2018. So far so good!

 

[ivinsfan]

Me too! I'm on the Walmart Humana plan. Was $30 and now is $62 next year. Sad part is that I only have two inexpensive Rx's. What?
Ok, it's only an extra $30 a month but still........

Apparently we are in the same plan, these are my numbers exactly. I'll be looking for something. else during open enrollment. I have to say it's confusing because one would think that the cheapest plan is going draw people with minimal drug cost.

Went on MC exactly one year ago tomorrow and my original cost for that plan was around 20 bucks a month.

 

[Chuckanut]

It’s the price of drugs that’s the problem.

Write your Congress person. Maybe we can get their attention.

 

[Teacher Terry]

Aja, my DIL is only still alive because she could go out of state to the best surgeons. I would never take a advantage plan.

 

[mf15]

Just go the medicare and you book in the mail, looks like they are really pushing MA plans. I also see a high MOOP for many. Also interesting they provide all the plans for your state, but don't list one medigap plan, where they used to list them. Also no plan G-HD.
Oldmike

 

[MBSC]

You can now window shop 2020 Part D & MA plans.

https://www.medicare.gov/

 

[Perryinva]

Wife (66) is on Aetna Plan D and premium notice just sent says it goes from $16.10 to $16.50, but with a $45 increase in the deductible. She blows through the deductible in the first 2 months, and the plan works well for us, costing much less than we save over GoodRx. I (61) am on the Kroger Pharmacy plan, which was $32 for an entire year and my Lisiniprol, and Metformin are zero copay (free) under the plan. My other drug went from $125 to $16. The only reason we have her on Plan D is it (as well as Plan G) is no cost to us (nor will mine be when I turn 65) as a supplement reimbursement retirement benefit as an addition to my pension, up to $1200/yr/person. If you don’t get it, then you don’t get the reimbursement, and if down the road we need those plans then the added cost penalty is pretty bad. If we signed her up for the Kroger plan, none of hers were any less than through Plan D, so no point.

 

[MBSC]

Some consumer advocacy groups are not fans of the new Medicare Plan Finder tool.

The ability to sort plans by Total Cost (out-of-pocket + annual premium) will be added by start of Open Enrollment on October 15.

5. In the old Plan Finder, a user could sort the drug plans available in the ZIP code by total cost. This feature is not included in the new Plan Finder – will it be added?

Yes, we have always planned to include the option to sort plans based on Total Annual costs by Open Enrollment, and development of that feature is on track.

Source: https://cmsnationaltrainingprogram.cms.gov/system/files_force/Medicare%20Plan%20Finder%20Top%2010%20Questions%20-%20508.pdf?download=1

 

[Telly]

Wife (66) is on Aetna Plan D and premium notice just sent says it goes from $16.10 to $16.50, but with a $45 increase in the deductible.....

Finally got my Annual Notice Of Change from Wellcare, who bought Aetna's Part D business. I was in the Aetna Medicare Rx Select, where I last paid $16.10. Wellcare created (or had) a Wellcare Medicare Rx Select plan, and that is their "if you do nothing" plan that supersedes Aetna's. New premium is $20.90, a 30% increase.

The deductible increased $35 from $380 to $415. Other changes are a $1 boost for Tier 2 preferred cost-sharing, increasing Tier 4 standard and preferred cost-sharing by 9 and 2 percentage points respectively. I think that's it for the changes. Still no deductible for Tier 1 and 2.

I don't have any prescription drugs, so other than maybe Shingrx to see what it looks like, I really don't have any drugs to enter (I'm not complaining about that ).

I'll poke around more when the Medicare website improves its Part D area for this year's geriatric sharkfest.

 

[Gill]

This is an entirely new plan put out by Humana. They still offer their original plan which will have a premium of $13.40 in Florida. I received the same notice which is deceiving and doubled the premium. I will be switching to the basic plan.
Gill

 

[Sunnymar]

I got the same Humana plan a few years ago, now waiting until the 15th to switch to Humana Value or BCBS.

 

[Gill]

I got the same Humana plan a few years ago, now waiting until the 15th to switch to Humana Value or BCBS.

There is going to be some massive switching. I will save about $1,100 in premiums by switching to the basic plan for my wife and me. I realize drug costs could be higher but not likely by anything near that amount.
Gill

 

[eddiegorniakjr]

I just received the Annual notice of changes for my Plan D from Humana RX plan. Premium goes up for 2020 from $26.60 a month to $56.60 - 113% increase. All I can say is wow. Time to start researching other plans. We are fortunate (wife and I) that our prescription needs so far are minimal but this is outrageous. I've never seen such an increase year to year in any insurance coverage on my seven decades on this earth.

Humana raised mine from 26.30 to 55.10.
I don't take any medicines.
I recieved a phone call from a salesman from quickquote I think.
He wants me to switch to aarp medicare advantage plan 1.
It is free and includes drug coverage.
I currently only pay for medicare a. b. and d.
If I take this plan 1 I don't need a separate drug plan.

 

[omni550]

Humana raised mine from 26.30 to 55.10.
I don't take any medicines.
I recieved a phone call from a salesman from quickquote I think.
He wants me to switch to aarp medicare advantage plan 1.
It is free and includes drug coverage.
I currently only pay for medicare a. b. and d.
If I take this plan 1 I don't need a separate drug plan.

Correct. But please research Advantage Plans before you commit.

omni