Medicare Part D 2021 price increases

[Buckeye]

No offense taken--But why pay $48 more if you can get the exact same thing or better cheaper? Don't you comparison shop when you go to the grocery? Being retired I have plenty of time to do the comparison shop on the Medicare site--it will only take a few minutes. Besides, everyone on Part D should look at the Medicare site every open season because all plans make changes every year and the plan you are on may not work for you anymore.

This is the way I was able to retire at age 50--look after the pennies and the dollars take care of themselves.

Yes, so important to review every year for changes. I did this every year for my mother. No downside to changing and it's easy. Paying extra $ to insurance companies for nothing is not on my bucket list.

 

[ShokWaveRider]

Aetna's SilverScript will have a new plan for 2021 called SmartRx. The premium is $7.50 in most states and it's available in all 50 states. $0 deductible for Tier 1, $445 deductible for tiers 2-5. Page 2 of the PDF below lists the actual premium in each state and the preferred pharmacies.

SmartRx: https://nebula.wsimg.com/ae8bb99a2c...1737DEA001C86DFFB&disposition=0&alloworigin=1

Thanks, this would be my choice, I take 4 tier 1 drugs for BP and Cholesterol. 2 are free at Publix here in Florida. I for one will move from Wellcare to Aetna in 2021.

 

[badatmath]

No offense taken--But why pay $48 more if you can get the exact same thing or better cheaper? Don't you comparison shop when you go to the grocery?

Sometimes, sometimes not. I guess I am not convinced you get "the exact same thing". No such thing as a free lunch. If I have to spend 3 hours cancelling, enrolling, etc I probably just don't care - not at that price. And you know all tp will get you clean but some is nicer/more convenient to use than others.

 

[harllee]

Sometimes, sometimes not. I guess I am not convinced you get "the exact same thing". No such thing as a free lunch. If I have to spend 3 hours cancelling, enrolling, etc I probably just don't care - not at that price. And you know all tp will get you clean but some is nicer/more convenient to use than others.

No way would you spend 4 hours--you do it all on the Medicare site and Medicare cancels and reenrolls you--I think last year I spent 20 minutes. Everyone needs to check on the Medicare site every year anyway to make sure your plan still covers your drugs ( the formulary of the plans change every year) so you will be spending the 20 minutes anyway. You will find out when you get on Medicare.

 

[audreyh1]

Sometimes, sometimes not. I guess I am not convinced you get "the exact same thing". No such thing as a free lunch. If I have to spend 3 hours cancelling, enrolling, etc I probably just don't care - not at that price. And you know all tp will get you clean but some is nicer/more convenient to use than others.

Well there is a free lunch when it comes to many types of insurance. Once they have you as a customer, they try to raise prices hoping you won’t notice. They reserve the discounts to attract new customers. It’s how the game is played these days. Some companies are more aggressive about it than others. If you aren’t vigilant you will be charged more for the exact same thing. I guess you don’t understand that many younger Medicare folks carry part D insurance even though they have no prescription drugs needs at all, but because they will be penalized in the future if they don’t. So of course we’re going to look for the cheapest plan, knowing that when it gets to needing prescription drug coverage we can change plans annually as our drug needs change.

Comparison shopping - company A sells a gadget at one price, company B sells the same gadget at a significant discount. Do you really tell yourself there is “no such thing as a free lunch” and ignore the discount? I don’t think so.

 

[Sarah S]

Smartrx looks to have an extremely limited formulary. I realize that a lot of people take no meds or just one or two common and cheap ones that are probably among the 96-98 they cover.

If you happened to need something off formulary even short term it could get very expensive ( or you could be tempted to ask for something on formulary that might be less effective )

I think that off formulary drugs do not count toward deductibles and the doughnut hole, is that right?

A year is a long time and anyone can get sick or injured. One pricey prescription could knock out any savings even if you then recovered

 

[Corporateburnout]

How about my plan that went up from $14.20 to $34.40 with no medication changes

EnvisionRx was acquired by Elixir and that's the only change that I've noticed.

 

[REWahoo]

How about my plan that went up from $14.20 to $34.40 with no medication changes

No more phone calls please, we have a winner.

 

[ShokWaveRider]

SmartRX Formulary Tier 1, 2 etc. seem to be the same for all plans, it is just what they pay that seems to be different between the Tiers. I looked up the formulary and it does seem to be specific to plans. At least not that I can find today. It may be a little early though.

 

[audreyh1]

Smartrx looks to have an extremely limited formulary. I realize that a lot of people take no meds or just one or two common and cheap ones that are probably among the 96-98 they cover.

If you happened to need something off formulary even short term it could get very expensive ( or you could be tempted to ask for something on formulary that might be less effective )

I think that off formulary drugs do not count toward deductibles and the doughnut hole, is that right?

A year is a long time and anyone can get sick or injured. One pricey prescription could knock out any savings even if you then recovered

It's just impossible to know what one might need until you need it. And formularies change annually for plans anyway. I'm not concerned. If something bad happens like an accident, or cancer diagnosis much will be covered until Part B as it's in hospital or in doctor's office for chemo. It might not be a whole year either. And once you need expensive prescriptions you have to comb through formularies every year to make sure you existing plan still covers you. DH is in very good health, so I don't even begin to see how he can pick a plan in anticipation of some possible future disease or need for painkillers for several months.

There are few long-term guarantees:

Most Medicare drug plans (Medicare Prescription Drug Plans and Medicare Advantage Plans with prescription drug coverage) have their own list of what drugs are covered, called a formulary. Plans include both brand-name prescription drugs and generic drug coverage. The formulary includes at least 2 drugs in the most commonly prescribed categories and classes. This helps make sure that people with different medical conditions can get the prescription drugs they need. All Medicare drug plans generally must cover at least 2 drugs per drug category, but plans can choose which drugs covered by Part D they will offer.

The formulary might not include your specific drug. However, in most cases, a similar drug should be available. If you or your prescriber (your doctor or other health care provider who’s legally allowed to write prescriptions) believes none of the drugs on your plan’s formulary will work for your condition, you can ask for an exception.

A Medicare drug plan can make some changes to its drug list during the year if it follows guidelines set by Medicare. Your plan may change its drug list during the year because drug therapies change, new drugs are released, or new medical information becomes available.

https://www.medicare.gov/node/39226

 

[Sue J]

DH and I started Medicare this year so we haven't gone through the Part D yearly open enrollment yet. For 2020 we both have Wellcare for $14.20 each. My Rxs are all tier 1, cost $0 and I get them from the mail order CVS Caremark or our local grocery store preferred pharmacy. DH has two Tier 2 Rxs that cost $5/mo through the local preferred pharmacy. Wellcare has been great since we started but I am very interested in this Aetna SilverScript SmartRx for $7.50/mo!

When we started Medicare I used a comparison tool on the Medicare site to compare plans and costs. When is this usually updated? I checked and it's still using 2020 plans.

The SilverScript SmartRx formulary being limited to 98 drugs makes me want to verify that our current Rxs are included. We take very common stuff so I'm hoping this plan may work for us.

 

[Sarah S]

Most people will be lucky and get away with it but as a physician I do not see less than 100 drugs giving me an option in every class and category for all conditions or even every common condition. Most formularies , even the ones that seem restrictive, contain many many more drugs than 100. I can completely see looking at someone and saying none of these drugs will work. I have never had to say that with any other formulary and Massachusetts had restrictive formularies long before the rest of the country.

Again, most people who start the year without significant issues will be fine.

 

[CRLLS]

I'm chiming in. 2020 Wellcare Wellness Rx monthly is $13.20 for us. I just minutes ago, received my 2021 increase notice. It will go up to $14.70, which seems like a small amount. But if you figure it is a 11.3% increase, not so small an increase. I'm not complaining too much since I was expecting a higher increase based on some of the earlier posts.

Aetna's Silver Script would be much lower percentage wise, but not a lot in real dollars. We will stay with Wellcare I think. So far it has been good for us. Only one time this year we have had to defer to GoodRx for a much lower cost on a non-tier1 med.

 

[Sue J]

The SilverScript SmartRx formulary being limited to 98 drugs makes me want to verify that our current Rxs are included. We take very common stuff so I'm hoping this plan may work for us.

Quoting myself because I'm taking that back! DH takes nadolol and according to the SilverScript formulary for 2020 that drug is not covered at all and he'd pay full retail price, about $100/mo. Before Medicare we bought this at a local pharmacy using GoodRx or Rx Saver coupons and the price was $55-$89 for 3 months depending on which way the wind was blowing.

If it's not covered for 2020 I expect it won't be included in their 2021 formulary. I'll still check for my own Part D but DH will probably stay with his current Wellcare where this Rx is covered and costs $5/mo.

 

[Telly]

For those considering the Aetna SilverScript SmartRX, please note that the deductible starts at Tier 2, which is, at least to me, unusual. Most plans are Tiers 3 - 5. Their next more expensive plan has the deductible starting at Tier 3.

It seems funny to hear that Aetna is back in the Part D business! To get federal approval (DOJ?) for CVS Health to acquire Aetna a couple years ago, Aetna had to divest itself of its large Part D business, which was sold to WellCare.

So it looks like CVS Health is now selling Part D plans under its own "Aetna" subsidiary name. Makes sense, I would think CVS Health would want to start cashing in on the "goodwill" that they spent billions for in purchasing Aetna. Just sounds funny as I had signed up with Aetna Part D when I started Medicare.

 

[ShokWaveRider]

Has anyone actually seen the formulary for Aetna Silverscript SmartRX? I would not find it.

 

[harllee]

DH and I started Medicare this year so we haven't gone through the Part D yearly open enrollment yet. For 2020 we both have Wellcare for $14.20 each. My Rxs are all tier 1, cost $0 and I get them from the mail order CVS Caremark or our local grocery store preferred pharmacy. DH has two Tier 2 Rxs that cost $5/mo through the local preferred pharmacy. Wellcare has been great since we started but I am very interested in this Aetna SilverScript SmartRx for $7.50/mo!

When we started Medicare I used a comparison tool on the Medicare site to compare plans and costs. When is this usually updated? I checked and it's still using 2020 plans.

The SilverScript SmartRx formulary being limited to 98 drugs makes me want to verify that our current Rxs are included. We take very common stuff so I'm hoping this plan may work for us.

The dates to change Part D run from 10/15 to 12/7. The Medicare comparison site should hopefully be available by 10/15.

 

[badatmath]

Whole process sounds annoying but it is quite a ways off for me so who knows what they will play by then.

 

[harllee]

Whole process sounds annoying but it is quite a ways off for me so who knows what they will play by then.

It is somewhat annoying but the Medicare website is good. The real annoying part is that people on Medicare still have to pay a lot for their prescriptions-- Part D is not full coverage by any means. But it is better than it was 20 years ago when most people over age 65 had no prescription coverage. My mother age 90 has told me how awful it was for her.

 

[badatmath]

My mother age 90 has told me how awful it was for her.

Probably why my grandma never went to a doctor until they took her to one in an ambulance when she fell down a flght of stairs and broke her hip.

 

[audreyh1]

The dates to change Part D run from 10/15 to 12/7. The Medicare comparison site should hopefully be available by 10/15.

Right, no point in calling Boomer Benefits before then.

 

[MBSC]

As in previous years, the updated Medicare Plan Finder on Medicare.gov will be available October 1.

In the meantime, Q1Medicare.com has very limited information on 2021 Part D Plans. Number of plans available, plan name and premium. NOT yet available are cost sharing and formulary. It also has a "2020/2021 Part D Comparison" section where you can see the premium changes.

Starting on October 1, you can take an early peek at Medicare health plans and drug plans by using the Medicare Plan Finder. If you have a Medicare Number, you can log in or create an account to put together or access a list of your drugs...

Source: https://www.medicare.gov/blog/medicare-open-enrollment-set-a-reminder

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How about my plan that went up from $14.20 to $34.40 with no medication changes.

EnvisionRx was acquired by Elixir and that's the only change that I've noticed.

I have no firsthand knowledge of the following, only secondhand information. Envision is mapping some Plus Plan members (except NY, DC, MD, SC, and DE) to a higher priced Elixir plan. You have to manually change to the lower priced Elixir Plus plan ($16 range for 2021).

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I see the plan for $7.50. Is it saying it covers only 98 different drugs?

See below. I increased the font size for you. The 98 is only referencing the 100 most common drugs so the total formulary is larger, but basic plans do have smaller formularies. CMS has regulations on minimum overall formulary size as Audreyh1 pointed out. This plan is only for those on no prescriptions or a couple of Tier 1 drugs.

Each year, the question is asked about picking one plan and then going on a new non-formulary prescription mid-year. For inexpensive drugs, use a discount program like GoodRx. For expensive drugs, the prescribing doctor can submit a Formulary Exception Request to potentially have the drug added to the formulary for your account until the next AEP. Sample Exception Request Form: https://docushare-web.apps.cf.humana.com/Marketing/docushare-app?file=1828827

Formulary Coverage (6): 98

(6) Top 100 drugs most commonly prescribed to Medicare beneficiaries.

 

[harllee]

MBSC--thanks for all this information, very helpful. I have always waited until after 10/15 to do my Part D shopping on the Medicare site because I figure there could be some last minute changes.

 

[Corporateburnout]

I have no firsthand knowledge of the following, only secondhand information. Envision is mapping some Plus Plan members (except NY, DC, MD, SC, and DE) to a higher priced Elixir plan. You have to manually change to the lower priced Elixir Plus plan ($16 range for 2021).

Thanks for the info. I will most likely switch to another company during open enrollment and not bother with Elixir.

 

[lem1955]

I have Plan D with MutualofOmahaRx. I pay $21.40/month with a $435 deductible. After reading these posts I thought, I could probably find a cheaper plan. But then I looked into it further. I have one prescription for which I would pay $39.10/90 day supply except my plan charges $0 as long as I buy from CVS or ExpressScripts. It would do the same for a long list of generic drugs. I haven't received any renewal notices yet. For now, I'm sticking with this plan. Now I see Elixer has the same deal for the drug I use. I'll wait until all the prices are updated and then check again.