More Nasty and Unexpected Changes With Part D Plans Next Year

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drawpoker
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More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Sat Oct 05, 2019 5:28 pm

Here's a new wrinkle I just discovered with researching Medicare Part D plans for next year. Besides disappearing zero-deductible features, higher premiums, formulary changes, et al, the shifty insurers are now fiddling with the pharmacy network status (preferred and standard)

Here's what I just confirmed comparing Cigna-Health Spring diff. Part D plans (all 3). Had my interest spiked with their "Secure Extra" deal, $52 premium, $100 deductible but only on Tier 4 & 5. Best of all my pharmacy was listed as "preferred pricing" when drilling down.

But - when I finished entering my drug list for their cheaper Plan "Secure Essential", guess what, the message changed. Suddenly the very same pharmacy was no longer listed as "preferred" in their network but rather "standard" pricing.
WTH? This can't be right, so I called them to ask.

After the phone rep had to check with someone, sure enough, he came back and said, yeah, that is correct, it is no mistake.

I said - have I got this straight? The very same pharmacy to the very same insurance co. can be either preferred, or standard, depending on which particular company's Plan the subscriber is carrying?

Yup was the answer.

In 6 years of dealing with this annual Medicare hassle/headache every October I have never seen this before. Did I miss something in the news, anyone else here heard of this sneaky move?

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by jebmke » Sat Oct 05, 2019 5:35 pm

there isn't much standardization. Even the tiers are different from company to company.
When you discover that you are riding a dead horse, the best strategy is to dismount.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Sat Oct 05, 2019 5:39 pm

But this isn't "company to company" comparisons.

Katietsu
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Katietsu » Sat Oct 05, 2019 5:43 pm

I am not sure this is new. I am pretty sure that the “network” for the largest part D provider in the area where my parents lived has always varied depending on which plan you picked.

I recall having to explain to two neighbors that even though they had the same insurer, it was quite possible that neighbor A could go to location 1 but neighbor B could not.
Last edited by Katietsu on Sat Oct 05, 2019 5:45 pm, edited 1 time in total.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by jebmke » Sat Oct 05, 2019 5:45 pm

drawpoker wrote:
Sat Oct 05, 2019 5:39 pm
But this isn't "company to company" comparisons.
all the more chaos. That's why I'm tempted to do without. Just give up. If I run out of money, I'll just have my wife put a pillow over my face.
When you discover that you are riding a dead horse, the best strategy is to dismount.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by cashmoney » Sat Oct 05, 2019 5:47 pm

drawpoker wrote:
Sat Oct 05, 2019 5:28 pm
Here's a new wrinkle I just discovered with researching Medicare Part D plans for next year. Besides disappearing zero-deductible features, higher premiums, formulary changes, et al, the shifty insurers are now fiddling with the pharmacy network status (preferred and standard)

Here's what I just confirmed comparing Cigna-Health Spring diff. Part D plans (all 3). Had my interest spiked with their "Secure Extra" deal, $52 premium, $100 deductible but only on Tier 4 & 5. Best of all my pharmacy was listed as "preferred pricing" when drilling down.

But - when I finished entering my drug list for their cheaper Plan "Secure Essential", guess what, the message changed. Suddenly the very same pharmacy was no longer listed as "preferred" in their network but rather "standard" pricing.
WTH? This can't be right, so I called them to ask.

After the phone rep had to check with someone, sure enough, he came back and said, yeah, that is correct, it is no mistake.

I said - have I got this straight? The very same pharmacy to the very same insurance co. can be either preferred, or standard, depending on which particular company's Plan the subscriber is carrying?

Yup was the answer.

In 6 years of dealing with this annual Medicare hassle/headache every October I have never seen this before. Did I miss something in the news, anyone else here heard of this sneaky move?



Usually it's the " value " plan in a carriers part D lineup that will have the leaner pharmacy network.This is nothing new.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Ged » Sat Oct 05, 2019 5:52 pm

Confusopoly def: confusing marketing designed to prevent the buyer making informed decisions.

Origin: Scott Adams

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Sat Oct 05, 2019 5:56 pm

cashmoney wrote:
Sat Oct 05, 2019 5:47 pm

Usually it's the " value " plan in a carriers part D lineup that will have the leaner pharmacy network.This is nothing new.
Yeah, get that, but no, that's not the issue. Maybe I didn't explain it adequately.

The network of individual pharmacies the Plan has picked can vary greatly. What I am saying is that pinpointing a particular pharmacy within the network, then changing the designation from preferred to standard according to just which Plan was selected, is news to me. Even the rep I spoke with at Cigna stated it was something new starting next year.

Whether he got that after checking with supervisor, or, just said something off the top of his head to please a caller, I dunno.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by bob60014 » Sat Oct 05, 2019 6:07 pm

"If you can't dazzle 'em with brilliance, baffle 'em with bull----.
W. C. Fields

I feel sorry for all those whose skills have declined, making a hard decision even harder. We are ok but still, at times, all the adjusting and shopping each year becomes a drag.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by nisiprius » Sat Oct 05, 2019 6:18 pm

Warning, conspiracy theory ahead: I think this is deliberate. I think they churn the plans every year so that the cheapest plan in year X becomes a meh plan in year X + 1. Everyone has to spend an hour a year, every year to review and switch plans or end up paying a 25-50% "loyalty tax."

I've noticed, too, that someone or something is often very late about updating the data on the Medicare "find-a-plan" website. Indeed, one year I switched plans unnecessarily, because in late December plan I was on was still showing $60-for-30-day-supply price on a very common, cheap prescription that's the Walmart $4 list. I actually called the plan and got no information beyond "that's what we are showing." I assume some business negotiation with the pharmacy chain I use wasn't finalized yet. Anyway, I got tired of waiting and switched to a plan that was showing me a $2 price.
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by celia » Sat Oct 05, 2019 6:34 pm

I’ve seen “preferred” vs “any” pharmacy since we’ve been on Medicare. I’ve also seen Insurance Company A with multiple plans, each with its own rules and formulary. The last time I looked, my densely-populated zip code had about 80 plans. How can anyone decide among that many? That is why we save our drug lists on the Medicare site and let the Medicare plan comparison tool find what’s best for us. (Besides the drugs we currently take, we also do a “what if” adding drugs our doctors have mentioned for future consideration.)

Even though I print out the chart showing how much each drug will cost in each drug plan phase, I get frustrated since tiers 3 and 4 drug co-pays never match what is in the chart. (The manufacturers change their prices or negotiate rates a month into the new year!?@*)

What do the elderly do who come in with the “correct” amount for the co-pay only to find out the price is now different? For 3 years I tried to understand how the co-pays were calculated, but now I’ve given up.
Last edited by celia on Sat Oct 05, 2019 6:39 pm, edited 1 time in total.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Sat Oct 05, 2019 6:37 pm

Katietsu wrote:
Sat Oct 05, 2019 5:43 pm
...not sure this is new.......recall having to explain to two neighbors that even though they had the same insurer, it was quite possible that neighbor A could go to location 1 but neighbor B could not.
Are you certain these 2 both had Part D PDP plans with same company? This sounds suspiciously like Neighbor A might have had an actual Part D plan with insurer Z, but Neighbor B had a Medicare Advantage plan with insurer Z.
Same insurance company, but different networks for their drug coverage benefits. Not unusual.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by nisiprius » Sat Oct 05, 2019 7:15 pm

Decided to peek at Part D plans on Medicare.gov.

The new Part D find-a-plan website is a disaster. Some lowlights.

1) It shows an erroneous town name shown for my ZIP code. Fortunately pharmacies, etc. appear to be correct (i.e. based on the ZIP code, not the town name).

2) It does not seem to be possible to use the website to obtain the total annual cost of premiums + drugs. In the past that was the most prominent number shown. In the past, you not only saw the total, you could actually drill down into a bar chart showing month-by-month prices. That bar chart isn't available, and a choice that promises "monthly cost" shows me only "November."

Even using a calculator, it does not seem to provide the numbers from which it is possible to calculate total annual cost (premiums + drugs).

3) The stated drug costs seem... unlikely.

4) The site says I will be paying a monthly price for two drugs of about $55, until I meet a deductible of $365. Yet it also says that I will not meet the deductible.

5) My current plan is listed at the top with a plan number. The lists of plans to compare with it includes a plan with an identical name, an identical plan number, a different monthly premium and a different deductible.
Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness; Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Sat Oct 05, 2019 8:22 pm

The Medicare dot gov website is notorious for containing errors when they first post all of the new Plan information every October. The mistakes slowly but gradually get corrected as they are learned.

We are always told, um, to be patient and understanding as Medicare has to load so much data involving hundreds and hundreds of Plans, both Part D and regular health plans, and there are so many changes from the prior year.

My patience is running a little thin however :oops:

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by nisiprius » Sat Oct 05, 2019 8:33 pm

But ZIP codes haven't changed this year. Well, mine hasn't and most haven't.

So I would like to know if this is just some weird glitch.

Medicare.gov, Preview 2020 health and drug plans, log in, Drug Plan (Part D), Enter your ZIP code. Try it. See if you can reproduce the problem.

I just tried 19482, which is the ZIP code for Vanguard's office in Valley Forge, PA, and it thinks it is in Chester, PA, which is twenty miles from Valley Forge and has a ZIP code of 19013!

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Sat Oct 05, 2019 8:44 pm

Mine is working okay but that may be my zip has a unique default. It includes two counties so the pop-up always appears asking which county.
btw, why do you bother to log in to the site? :? When I do that, it only accomplishes 2 things: They greet me by name :P , then remind me of what current Part D plan I am in. As tho I am senile and wouldn't remember otherwise w/out the reminder. :annoyed

Other than that, all other screens that open up appear to be exactly the same.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Pacific » Sun Oct 06, 2019 3:48 am

The zip code search box is a fiasco. According to the site, my favorite Costco Pharmacy no longer exists. There is no way to add it. Unbelievable. (or maybe not)

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by nisiprius » Sun Oct 06, 2019 7:27 am

You know what? I've decided not trust any information available on Part D plans just yet... if I can't get any better information I'll just stick with the plan I've got and hope I don't get rooked too badly. And give thanks that I currently only use two cheap, common prescriptions (both on the Walmart $4 list if worst comes to worst).

I spent about twenty minutes on the phone with Medicare asking for help understanding the information on the site. The representative was intelligent, understood my questions, and was in fact able to log into the site with my information and view directly what he saw. In all cases he saw the same thing, this wasn't any browser-related issue.

Apparently the new site is... very new. Seemingly he had never seen it before and had not been trained on it. And all the things I couldn't understand, he couldn't understand. He, too, was completely baffled by the site's displaying two Part D plans with identical names and identical plan numbers, yet different premiums and deductibles.

He, too, could not figure out how to calculate total annual cost based on the information provided (premiums + drug prices before deductible met + drug prices after deductible met).

For example:
You're previewing 2020 plans.

Total monthly premium $14.50
Drug plan deductible $365.00
Monthly totals:

Retail cost $36.51
Cost before deductible: $36.51
Cost after deductible: $36.51
Cost in coverage gap $11.12
Cost after coverage gap $3.40

Based on current drug costs, it's estimated that:
You won't meet your $365.00 deductible this year
He, too, could not figure out how you could get from "$36.51" per month to "won't meet your $365 deductible this year."

He ended up laughing because it was so insanely bad, and we had a pleasant moment. After we finished I was quite puzzled as to how to answer the stupid satisfaction survey, because I didn't want to give him a bad grade, but on the other hand the overall experience was completely unsatisfactory.

I can try to reverse-engineer some explanations, such that perhaps the site is claiming to be previewing 2020 plans but is actually showing me 2019 plans, or that the site doesn't have plan prices and is just plugging in full retail prices for everything because it doesn't know any better.
Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness; Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Ron » Sun Oct 06, 2019 8:10 am

drawpoker wrote:
Sat Oct 05, 2019 8:22 pm
The Medicare dot gov website is notorious for containing errors when they first post all of the new Plan information every October. The mistakes slowly but gradually get corrected as they are learned.
Correct.

I've learned over the years not to sign up for a new plan since there is possibly a "better" plan in the offing if I wait until closer to the end of the open enrollment date, rather than sign up/cancel a plan early in the cycle.

- Ron

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by rustymutt » Sun Oct 06, 2019 8:24 am

This is a mess every year with me missing coverage in the whole of January, becau'se the insurance agent had to call me and confirm my corverage never called. If I'd been sick that month, I could have lost alot. Confuse and dazzle, then market to them. All the time raising rates yearly. I'm thankful for my companies insurance plan, but leadership in this area is not only lacking, but non-existant because of money influence. Everything in retirement becomes self serve, just like the full service grocer, becoming a thing of the past.
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by MJS » Sun Oct 06, 2019 8:39 am

Pacific wrote:
Sun Oct 06, 2019 3:48 am
The zip code search box is a fiasco. According to the site, my favorite Costco Pharmacy no longer exists. There is no way to add it. Unbelievable. (or maybe not)
Plans are listed by county (not city, town or village.) Pharmacies are listed by zip code.

If your Costco is in the same county as your residence, use the Costco's zip code. You still get your county's plans, but that zip code's pharmacies. In the West, with giant counties, this works well. In the East, with teensy tiny counties... probably not.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by kaneohe » Sun Oct 06, 2019 8:43 am

nisiprius wrote:
Sun Oct 06, 2019 7:27 am
.....................................................................
He, too, could not figure out how to calculate total annual cost based on the information provided (premiums + drug prices before deductible met + drug prices after deductible met).

For example:
You're previewing 2020 plans.

Total monthly premium $14.50
Drug plan deductible $365.00
Monthly totals:

Retail cost $36.51
Cost before deductible: $36.51
Cost after deductible: $36.51
Cost in coverage gap $11.12
Cost after coverage gap $3.40

Based on current drug costs, it's estimated that:
You won't meet your $365.00 deductible this year
He, too, could not figure out how you could get from "$36.51" per month to "won't meet your $365 deductible this year."
......................................................................
I too am a bit confused by the outputs........mainly, I put in both mail order and retail pharmacy. I expected to see monthly prices for
retail and quarterly prices for mail order. All outputs are labeled monthly cost . However the detail for all shows a detailed monthly
listing only for Jan/April/July/Oct.
I concluded that perhaps the "monthly" label was incorrect and quarterly was more correct and if true
the totals did not meet the annual deductible as stated. The mail order and retail prices were in the same range so seemed "reasonable".
If I had multiplied the monthly number by 12 for retail, the difference would have been much larger.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by WillRetire » Sun Oct 06, 2019 9:06 am

It is still early. While the insurers & medicare.gov claim to have the data to enable you to shop & compare plans, the data is still rough & changing. Don't take any of it very seriously until after October 15th when open enrollment begins.

The method we use:
1. Compare plans on medicare.gov using drug list for ongoing meds. Look at top 3 or 4 for total lowest cost
2. Double-check the numbers for the top plans on the insurers' site(s).
3. Repeat 1 & 2 again in November before making decisions.

This is not for the faint-hearted, or for those who are not detail-oriented. It is tedious.

Help your elderly relatives shop for a PDP each year to help them save money. Or help them get in touch with reputable brokers through center for aging.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Sun Oct 06, 2019 1:35 pm

Pacific wrote:
Sun Oct 06, 2019 3:48 am
The zip code search box is a fiasco. According to the site, my favorite Costco Pharmacy no longer exists. There is no way to add it. Unbelievable. (or maybe not)
About as bad as showing defunct pharmacies still in network.

In comparing the various Humana plans for my area they are showing one drugstore that went out of business in 2014 and another that closed its doors for good at the end of 2016. Really.

Can Someone please tell me how this could happen :?:

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by jebmke » Sun Oct 06, 2019 2:27 pm

WillRetire wrote:
Sun Oct 06, 2019 9:06 am
Help your elderly relatives shop for a PDP each year to help them save money. Or help them get in touch with reputable brokers through center for aging.
Around here our SHIP person is extremely knowledgeable on Rx plans and assists those who struggle with the configurators. Not all SHIP people may be as well trained but it is worth checking.
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by kaneohe » Sun Oct 06, 2019 2:49 pm

Hope you folks are using the feedback button on the right hand side of the medicare.gov plan finder site. May not help if you do........but for sure it will not help if you don't.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by nisiprius » Sun Oct 06, 2019 3:01 pm

drawpoker wrote:
Sat Oct 05, 2019 8:44 pm
...why do you bother to log in to the site? :? When I do that, it only accomplishes 2 things: They greet me by name :P , then remind me of what current Part D plan I am in. As tho I am senile and wouldn't remember otherwise w/out the reminder. :annoyed
On both the old and new sites, when I log in it remembers my drug list without my needing to re-enter it.
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Tdubs » Sun Oct 06, 2019 3:35 pm

I can see that i'm not going to enjoy this.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by cashmoney » Sun Oct 06, 2019 3:45 pm

drawpoker wrote:
Sat Oct 05, 2019 5:56 pm
cashmoney wrote:
Sat Oct 05, 2019 5:47 pm

Usually it's the " value " plan in a carriers part D lineup that will have the leaner pharmacy network.This is nothing new.
Yeah, get that, but no, that's not the issue. Maybe I didn't explain it adequately.

The network of individual pharmacies the Plan has picked can vary greatly. What I am saying is that pinpointing a particular pharmacy within the network, then changing the designation from preferred to standard according to just which Plan was selected, is news to me. Even the rep I spoke with at Cigna stated it was something new starting next year.

Whether he got that after checking with supervisor, or, just said something off the top of his head to please a caller, I dunno.

It has been that way forever.I know I have ran literally thousands of part D reports on this website .It was probably an inexperienced customer service rep at Cigna. Whats new for 2020 in the medicare.gov is the giant font which in my opinion makes it harder to scan through and you now have to create an account to be able to save your drug list.This will make it harder for people who rely on help from ,SHINE,insurance agents etc.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Mlm » Sun Oct 06, 2019 4:02 pm

I'll be needing Medicare soon so I just checked the "Annual Notice of Changes for 2020" for the Medicare Advantage plan I am leaning towards. Yup, right there under changes for 2020 it says under Part D prescription drugs that there are now "preferred cost sharing" and "standard cost sharing" Providers. Prescriptions are $5 more if you don't use a preferred pharmacy.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Northern Flicker » Sun Oct 06, 2019 4:07 pm

Wouldn’t this be a small issue compared to whether or not a pricey medication is covered?
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Sun Oct 06, 2019 7:58 pm

I wouldn't consider it a "small" issue when you factor in that you would be paying a higher price for every single script you fill. Not just the "pricey" ones. If you mistakenly sign up for a Plan where the most convenient pharmacy for you is standard, not preferred, in the insurer's network.

Ex: A lot of people being discharged from the hospital have a fistful of scripts to fill. Oftentimes, the helpful social worker, or discharge coordinator, will suggest getting them all filled from the pharmacy affiliated with the hospital. Just downstairs, so convenient, you won't have to ask a friend or neighbor to do it when you get home.

Never again! The differences in co-pays I paid were eye-popping over what it would have been at the preferred status store. :x

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by nisiprius » Sun Oct 06, 2019 8:41 pm

Northern Flicker wrote:
Sun Oct 06, 2019 4:07 pm
Wouldn’t this be a small issue compared to whether or not a pricey medication is covered?
Yes. And it still makes me angry that you are required to commit for a whole year, but they are only required to stick to the formulary for 60 days. In short, you are buying a pig in a poke. You do not know whether your drug list is going to be covered for more than the first sixty days. Since there haven't been floods of horror stories about this, in practice the insurers must not be using their right to change the formularly abusively--but it is an offensively one-sided deal.
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Northern Flicker » Mon Oct 07, 2019 4:10 pm

It is absurd that they can get away with that, but I’d think a bigger risk is a new prescription during the year is not on the formulary.

I think the complexity of Medicare choices in general have become ridiculous. It could be simplified:

• No premiums
• $10K annual deductible and out-of-pocket max
• No distinction between hospital care, outpatient care, or pharmacy for deductible/OOP-max
• Enroll once at age 65
• Supplemental policies sold for those who want insurance to cover the $10K deductible

I’m not sure if $10K is the magic number that makes it revenue neutral compared to what we have now, but the threshold would be chosen to achieve that or achieve stability of program funding.
Last edited by Northern Flicker on Mon Oct 07, 2019 4:46 pm, edited 1 time in total.
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by midareff » Mon Oct 07, 2019 4:12 pm

Sorry to be a biut cavalier about it but the real solution is to retire with enough of an income stream where the year to year changes just don't matter much.

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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Carl53 » Mon Oct 07, 2019 4:23 pm

midareff wrote:
Mon Oct 07, 2019 4:12 pm
Sorry to be a biut cavalier about it but the real solution is to retire with enough of an income stream where the year to year changes just don't matter much.
Two big problems with the way it is, not that I could not afford to be ripped off every year for a few thousand. First, I don't like the major changes in the same plans year over year. Formulary changes, tier changes, price changes necessitate a time consuming review of many plans to keep the new damage down to the hundreds of dollars. Second, as Nisi pointed out, the terms and formulary are not locked in for the upcoming year.

What we want is a reliable plan that we can determine is the best for ourselves and does not change in formulary or tiers and not more than modest amount in annual changes for plan and drug costs.

jdb
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by jdb » Mon Oct 07, 2019 4:37 pm

As a newbie applying for first Plan D supplement starting next week this is crazy news. My question is why bother? Why not go cold turkey and just pay out of pocket? Are prescription drug prices higher for those without insurance? My current cost quite reasonable especially using Good Rx coupons at Costco pharmacy. Not looking forward to navigating this maze.

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drawpoker
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Mon Oct 07, 2019 4:40 pm

First, get the terminology straight. It is Part D, not Plan D supplement. You need to speak knowledgably, otherwise, you will be easy pickings for slick, unethical insurance brokers. Of which there are plenty out there, eager to pounce on the senior market. I don't have to explain the reason why, do I. :(

2nd, if you go without Part D insurance, then later try and sign up, you will be penalized for the rest of your life. The penalty is in the form of a percentage surcharge tacked on to your premium - permanently (no matter what company you sign with)

The percentage is calculated based on the no. of months you go without creditable coverage. It isn't pretty.

neilpilot
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by neilpilot » Mon Oct 07, 2019 5:12 pm

jdb wrote:
Mon Oct 07, 2019 4:37 pm
As a newbie applying for first Plan D supplement starting next week this is crazy news. My question is why bother? Why not go cold turkey and just pay out of pocket? Are prescription drug prices higher for those without insurance? My current cost quite reasonable especially using Good Rx coupons at Costco pharmacy. Not looking forward to navigating this maze.
Well I'm no great intellect, but don't find "navigating this maze" especially difficult. Simply plug any maintenance prescriptions you are taking into the on line Part D calculator, and pick the plan that works for you at a pharmacy you would like to use. I've been doing that for my DW and I since 2015, and it only takes a few minutes (especially since the system carries over your medication list year-to-year).

Broken Man 1999
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Broken Man 1999 » Mon Oct 07, 2019 5:57 pm

jdb wrote:
Mon Oct 07, 2019 4:37 pm
As a newbie applying for first Plan D supplement starting next week this is crazy news. My question is why bother? Why not go cold turkey and just pay out of pocket? Are prescription drug prices higher for those without insurance? My current cost quite reasonable especially using Good Rx coupons at Costco pharmacy. Not looking forward to navigating this maze.
IMHO, better to sign up for cheapest plan to avoid the penalty that will be applied forever. MIL went your route for years, and paid for not having a plan.

As well, you might need some prescription drugs at any time unless your crystal ball tells you that you won't need any during the coming year.

There is plenty of time to figure all this out.

Given the ability of so many here to figure the CGR of the three fund portfolio down to the seventh decimal place, I believe most can navigate this insurance maze.

BTW, a lot of the info is printed in the back of your copy of Medicare and You - 2020.

And, for those who need some help, it is available for free via various entities in your state. Just google it.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

Northern Flicker
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Northern Flicker » Mon Oct 07, 2019 6:32 pm

Well I'm no great intellect, but don't find "navigating this maze" especially difficult. Simply plug any maintenance prescriptions you are taking into the on line Part D calculator, and pick the plan that works for you at a pharmacy you would like to use. I've been doing that for my DW and I since 2015,
When you turn 90?
Risk is not a guarantor of return.

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drawpoker
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Mon Oct 07, 2019 6:39 pm

neilpilot wrote:
Mon Oct 07, 2019 5:12 pm
........and pick the plan that works for you at a pharmacy you would like to use......
Obviously you live in a big city, urban area. In rural areas the pharmacy you would "like to use" is likely not in many Plan offerings as a designated "preferred pricing" one in their network. :annoyed :annoyed

neilpilot
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by neilpilot » Mon Oct 07, 2019 8:52 pm

Northern Flicker wrote:
Mon Oct 07, 2019 6:32 pm
Well I'm no great intellect, but don't find "navigating this maze" especially difficult. Simply plug any maintenance prescriptions you are taking into the on line Part D calculator, and pick the plan that works for you at a pharmacy you would like to use. I've been doing that for my DW and I since 2015,
When you turn 90?
I was replying to jmb, who is self-described as "a newbie applying for first Plan D supplement". I seriously doubt that they are turning 90, although I guess that's possible.

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dodecahedron
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by dodecahedron » Mon Oct 07, 2019 9:13 pm

nisiprius wrote:
Sun Oct 06, 2019 8:41 pm
Northern Flicker wrote:
Sun Oct 06, 2019 4:07 pm
Wouldn’t this be a small issue compared to whether or not a pricey medication is covered?
Yes. And it still makes me angry that you are required to commit for a whole year, but they are only required to stick to the formulary for 60 days. In short, you are buying a pig in a poke. You do not know whether your drug list is going to be covered for more than the first sixty days. Since there haven't been floods of horror stories about this, in practice the insurers must not be using their right to change the formularly abusively--but it is an offensively one-sided deal.
Before you get too angry at the *insurance companies*, I think it is important to bear in mind that the insurance companies have to commit to a fixed premium for the entire year, even though the drug companies are free to change prices (sometimes quite outrageously) with no notice whatsoever. There were 41 drugs that had their prices raised by more than 100% in the first half of 2019. One of those drugs went up by 879% earlier this year!

My understanding is that IF you are already taking a particular drug at the time the mid-year formulary change kicks in, you may have certain rights to stay on the drug, possibly for the entire remainder of the year, depending on the reason for the change. Details described here.

So midyear formulary changes most strongly affect patients who have not yet begun taking a particular drug.

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dodecahedron
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by dodecahedron » Mon Oct 07, 2019 9:23 pm

nisiprius wrote:
Sun Oct 06, 2019 8:41 pm
Northern Flicker wrote:
Sun Oct 06, 2019 4:07 pm
Wouldn’t this be a small issue compared to whether or not a pricey medication is covered?
Yes. And it still makes me angry that you are required to commit for a whole year, but they are only required to stick to the formulary for 60 days. In short, you are buying a pig in a poke. You do not know whether your drug list is going to be covered for more than the first sixty days. Since there haven't been floods of horror stories about this, in practice the insurers must not be using their right to change the formularly abusively--but it is an offensively one-sided deal.
Also, it pays to check the fine print! There is an obscure (to me, and I suspect to most folks) provision in my state (NY), that allows me to do an annual mid-year change in my Part D coverage for any reason, as long as I am covered by a state supplementary prescription plan. This state supplementary plan is free and available to any household with income under $75K for a single and $100K for a married couple. It covers a lot of costs that Part D plans don´t pick up and also gives an extra mid-year opportunity to switch Part D carriers for any reason. The state supplementary plan is called EPIC in NY. And you can sign up for EPIC at any time. Perhaps other states have something similar?

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drawpoker
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Mon Oct 07, 2019 9:38 pm

dodecahedron wrote:
Mon Oct 07, 2019 9:23 pm
.....The state supplementary plan is called EPIC in NY. And you can sign up for EPIC at any time. Perhaps other states have something similar?
Yes, they are called SPDAP's (Seniors Prescription Drug Assistance Program) They can be anything the state decides they want to do, there are no rules.

In MD the program doesn't pay anything towards the actual drugstore costs, except for people who land in doughnut hole.
Otherwise, it pays up to $40 monthly toward Plan premium for singles with AGI below $37,800. Not sure of the ceiling for a couple, think it is around $56,000 or so. There are no other requirements or means testing; goes strictly by income.

It is nothing to sneer at, but not nearly as generous as the benefits you describe the Empire state doles out. :greedy

Edit: Correct income limit for a couple is $50,370, not $56,000.
Last edited by drawpoker on Mon Oct 07, 2019 9:55 pm, edited 1 time in total.

cashmoney
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by cashmoney » Mon Oct 07, 2019 9:46 pm

dodecahedron wrote:
Mon Oct 07, 2019 9:23 pm
nisiprius wrote:
Sun Oct 06, 2019 8:41 pm
Northern Flicker wrote:
Sun Oct 06, 2019 4:07 pm
Wouldn’t this be a small issue compared to whether or not a pricey medication is covered?
Yes. And it still makes me angry that you are required to commit for a whole year, but they are only required to stick to the formulary for 60 days. In short, you are buying a pig in a poke. You do not know whether your drug list is going to be covered for more than the first sixty days. Since there haven't been floods of horror stories about this, in practice the insurers must not be using their right to change the formularly abusively--but it is an offensively one-sided deal.
Also, it pays to check the fine print! There is an obscure (to me, and I suspect to most folks) provision in my state (NY), that allows me to do an annual mid-year change in my Part D coverage for any reason, as long as I am covered by a state supplementary prescription plan. This state supplementary plan is free and available to any household with income under $75K for a single and $100K for a married couple. It covers a lot of costs that Part D plans don´t pick up and also gives an extra mid-year opportunity to switch Part D carriers for any reason. The state supplementary plan is called EPIC in NY. And you can sign up for EPIC at any time. Perhaps other states have something similar?

True if your state has a SPAP (State Pharmaceutical Assistance Programs) and you enroll in it you then you have a Special Enrollment Period (SEP)to change PDP or MA plans once anytime throughout the year.Any knowledgeably agent will be aware of these and other SEPS available you.The ability these plans give you to switch your PDP plans is usually more valuable than the actual benefits you get from the plan.

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drawpoker
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Wed Oct 09, 2019 3:30 pm

Am *Bumping* this for the benefit of anyone who fails to recognize the significance of preferred cost sharing and standard cost sharing pharmacies within a Plan's network. Or, they realize it, but fall victim to some company's sneaky way of changing the designation according to whether you buy their "value" Plan. Or "premier" Plan. Or "Secure Plus". Or some other cutesy name they use that has absolutely no descriptive value at all. :annoyed

In poking around checking details for myself I happened to click on this hair-raising offering out there.

At preferred cost my simple Tier 1 generic would cost $3 for 90-day supply. At the standard cost that same 90-day supply would be $45.
For a Tier 2 drug, the same example is $9 versus $54. (This is EnvisionRx Plus for anyone who is interested)

Buyer beware.... :(

Carl53
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by Carl53 » Wed Oct 09, 2019 3:41 pm

The medicare site currently shows none of the pharmacies I might use as being preferred for 2020 plans. I hope by midmonth they will show that they are preferred. Right now all it shows is a bunch of scary out of network prices.

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drawpoker
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Re: More Nasty and Unexpected Changes With Part D Plans Next Year

Post by drawpoker » Wed Oct 09, 2019 3:50 pm

Don't trust the Medicare site yet! It is full of goofs.

If you see a Plan that might suit you, click on the "Plan website" button and go directly there to check pharmacies, drug prices, tiers, etc.

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