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Medicare Drug Plan Finder is a Mess . . . Again

For the 6th or 7th year in a row (I have lost count) the Medicare Plan Finder is a mess. CMS doesn't know the meaning of the term "user friendly".

 

And don't expect to get accurated copay's, at least for now. Usually takes CMS a couple of weeks, sometimes longer to get the kinks worked out.

 

There are often discrepancies in what the PF shows for preferred pharmacy's, tiers and copays vs what you will see on the carrier site. BEFORE COMMITTING TO ENROLLING IN A PLAN, COMPARE YOUR PF RESULTS AGAINST THE CARRIER SITE.

 

On top of this there is consolidation of plans and carriers. ExpressScripts was absorbed by Cigna. The plan you are mapped to may likely have a premium that is 2x your current premium.

 

Lot's of cost-shifting going on. Consumers will be taking a hit, especially on generics. My suggestion is to only use your PDP for brand name drugs where there are no generic equivalents. Instead of your drug plan, pay cash, use the store "discount" or other discount plan like GoodRx. Consider 90 day refills, and in some cases look at 12 month refills. 

 

This strategy may allow you to go with a lower premium plan if you only use your drug plan for brand name drugs.

 

Currently many carriers won't apply a deductible to tier 1 or 2 drugs. Most carriers for 2022 are applying deductibles to tier 2 and higher. A few carriers will apply the deductible phase to ALL drugs.

 

One carrier has only one preferred national pharmacy (Walgreens). If you enroll in their lowest premium plan you need to plan on filling only at Walmart.

 

Almost every plan has CVS, Costco, Kroger, Walgreens and Walmart as preferred pharmacy's. If you use any other drugstore you may be paying too much for your med's. 

 

There may be more surprises coming, so buckle up. It could get bumpy.


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There are so many variations in the drug end if you want to compare talk to a local expert. If you do not know one contact your local AARP Office to get one.

I have part D. Small deductible, no coverage gap, some co pay, a lot no copay and I pay no premium as it is part of my total medical coverage. Backing that up is our county drug discount program which covers all residing in county and cost us nothing.

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I’ve used the Medicare.gov Plan Finder for the last 5 years and have never experienced any problems. Matter of fact I estimate I’ve personally saved about $1500 in premium and drug costs those past 5 years.

 

I’ve also personally observed numerous part D insurance plan recipients save money through the Medicare.gov plan finder because they found lower premium and drug cost plans during Medicare Open Enrollment October 15 through December 7.

 

It’s a shame only 11% of part D prescription plan owners shop around each year for a less expensive plan.

 

That’s what insurance companies and their representatives hope for. They don’t want you to switch your plan from their company to another less expensive plan through another company. All the while as they steadily increase the plan costs each year.

 

I encourage everyone to check out the Medicare.gov plan finder website and learn how easy it is to navigate and save money.

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I am happy with the Medicare.gov Drug Finder.  All I do is enter my zip code, drugs and pick a nearby pharmacy.  Then I run the plan finder and look at the ones that have the cheapest "Yearly Drug and Premium Cost" first.  If I like the price of the cheapest plan that's the one I go with.  But if I look at other drug plans I never change my drugs, but I always verify that the plan considers my selected pharmacy a "PREFERED in-network pharmacy".  If my selected pharmacy is not a preferred pharmacy for that plan, I change my pharmacy to another nearby pharmacy that the plan does consider a preferred pharmacy.  That 'preferred' is important to see the best rates for that drug plan.

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@ReTiReD51 wrote:

 

 

It’s a shame only 11% of part D prescription plan owners shop around each year for a less expensive plan.

 

 

 


Maybe the problem is that so many Prescription Drug Coverage plans are intermingled with Medicare Advantage plans. (MAPD)  Sometimes there is a choice of keep your doctor or keep your medicine.  Sure there is probably something comparable but people seem to want what they want - 

 

Competition doesn't work if there is nobody looking, shopping and changing - MA plans seem to offer incentives for their Medicare Health plans but I don't see many of them offering incentives on their formulary side.  Oh, they may give some extra discounts on OTC - whoopee !

 

Unless people search out somebody to help them with their annual pick - they are lost.  That's why so many of them just put it on automatic pilot - then they can just grip about big pharma.

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
Conversationalist

@GailL1 you are correct in that, many folks who have an MAPD only look at provider networks from year to year and never consider the "D" part of the MAPD plans.

 

Many have $0 premium MAPD so they think they are "immune" to changes in plans from year to year and never bother to review them.

 

My thread starter is addressing the constant deficiencies and errors in the stand alone Part D plans. The casual consumer who only uses the PF once a year will probably not notice the problems.

 

But when you run HUNDREDS of comparisons and have a general idea of what a copay SHOULD be, you become acutely aware of how unreliable the Medicare PF is.

 

I could name numerous examples but here are a few.

 

One carrier I use a lot has at least one preferred pharmacy on their website for 2022 that is MIA on the Medicare PF. This year more than ever, it is incumbent on the part of the beneficiary to know which pharmacy's are preferred and which are not.

 

Over the weekend I ran a client report including 5 pharmacy's. The PF indicated 4 were preferred and one was standard. Yet the cost analysis showed LOWER copay's when using the standard pharmacy vs the 4 prefered pharmacy's.

 

Most folks probably won't notice these problems . . . until they try to use their plan next year.


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@somarco 

I noticed that CMS required the data from the insurers (3) months earlier than previously - they had to have 2022 rates / plan designs in by June 2021.  The 2022 Part D Plan Finder was suppose to be up by 10/01/2021 but OE doesn't start til 10/15/2021 - so maybe they built in a test period for a few days.  

 

Pharmacy list classifications seems a pretty basic thing - odd that would be incorrect ?!?

 

The site says that you can Preview now but cannot enroll until 10/15 - I hope people who preview will review again prior to booking a selected plan.  Course, the real test will come when they try to use the plan in 2022.

 

CMS Press Release - CMS Releases 2022 Premiums and Cost-Sharing Information for Medicare Advantage a...

 

Keep this community posted on what you as a professional are finding with the 2022 Part D Plan Finder.

 

It's Always Something . . . . Roseanna Roseannadanna
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@GailL1 the challenge to the Plan Finder is the data is only good as long as it is current.

 

As of today, star ratings are "coming soon". Personally, I don't put much stock in those but often the public considers them to be valuable.

 

And in some cases, preferred pharmacy's are different today vs 10/3/2021 when I first ventured into the water.

 

You cannot enroll in a plan until 10/15 but for the window shoppers that selected a plan early on and filed that away until 10/15, they may be disappointed when they try to use their plan next year.

 

I haven't seen a schedule for this year, but in the past CMS only updated their PF data 3x yearly while carriers can (and do) change pricing throughout the year.

 

Drug pricing is volatile and what you see today may not be so tomorrow.

 

Shop on the Plan Finder if you want but only trust carrier information for accuracy.

 

Or as Reagan said, "Trust but verify"

 

 


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@GailL1 once CMS standardized open enrollment, about 6 or so years ago, the "window shopping" time started 10/1. Agents could not access information for the next year nor could they discuss anything with clients prior to 10/1.

 

Once the public (including beneficiaries) were allowed to see new rates the problems (such as those I have listed and more) came to light. Of course there is no way to let CMS know about these issues. The only thing that can be done is tell the carrier who then tells CMS.

 

Until the 15th or later, you have no idea if the information is correct or not without 2x checking against the carrier.

 

Consumers can do that if they know how, but anyone with multiple clients doesn't have the time. Agents are not the only ones impacted, same is true for the folks at 800 MEDICARE, SHIP counselors and anyone else who helps consumers for free or a fee.

 

Some of the flaws in the past have existed into Nov in a few situations.

 

Some of my clients like the DIY approach so I always advise them to run reports during the window shopping time but DON'T enroll until the end of Oct or first week of November.

 

If you wait until 2022 to try out your new plan and discover a problem there is nothing you can do.

 

Last year (2020) I had a very angry client that filled her medication with her new card and using a preferred pharmacy. The Medicare PF said that drug was tier 2 and not subject to the deductible. In truth, it was classified by the carrier as tier 3 so her copay was considerably higher.

 

Fortunately I did not change her plan until the end of October and sent her a copy of the PF report. The "proof" wasn't good enough for her so she complained to the carrier. I think they made an exception for her but she still was mad at me.

 

Not my fault but all I can do is cover my backside with "proof" and let the chips fall.

 

There have always been issues with the PF but there are more than usual since Sebelius fired the company that managed the PF for years and hired an inexperienced company that contributed a lot of money to her campaign when she ran for state insurance commissioner. Sebelius is long gone but the problems created by her decision linger on.

 

I know some folks read my posts and are dismissive for different reasons. That doesn't bother me. Everyone has a right to make decisions based on their own research and filters.

 

Some critics may think my views are tainted and that is their prerogative. I formulate my opinion based on research, professional forums and real world (boots on the ground) experience.

 

As someone once said, "I am not always right but I am never wrong".


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You’re comparing apples to oranges.

 

I’m talking about Part D plans for original Medicare.

 

A part D prescription drug plan PDP is what you purchase with a Medicare supplement or Medigap plan. That’s what they refer to as Original Medicare.

 

Medicare advantage is a private insurance company plan that most times includes drug coverage. Hence MAPD. MA plans or sometimes called Part C are just another way to get your Medicare Part A and Part B coverage.

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It is an apple to apple comparison with a watermelon thrown in to boot.

 

Whether a stand alone PD or a MA-PD, beneficiaries still have to pick their drug plan - well, if they do.  The matter is more complicated in a MA plan because the beneficiary is trying to pick two different things - their medical coverage AND their prescription drug coverage within the same plan.

 

Medicare.gov - How Medicare Prescription Drug Coverage Works with a MA Plan or Medicare Cost Plan

 

KFF: Facts About Medicare Advantage Plans 2020 

From the above KFF link:

In 2020, nearly four in ten (39%) of all Medicare beneficiaries – 24.1 million people out of 62.0 million Medicare beneficiaries overall – are enrolled in Medicare Advantage plans; this rate has steadily increased over time since the early 2000s. Between 2019 and 2020, total Medicare Advantage enrollment grew by about 2.1 million beneficiaries, or 9 percent – nearly the same growth rate as the prior year. The Congressional Budget Office (CBO) projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to about 51 percent by 2030. . . . . 

 

. . . . In 2020, 90% of Medicare Advantage plans offer prescription drug coverage (MA-PDs), and most Medicare Advantage enrollees (89%) are in plans that include this prescription drug coverage. Nearly two-thirds of these beneficiaries (60%) pay no premium for their plan, other than the Medicare Part B premium ($144.60 in 2020). However, 18 percent of beneficiaries in MA-PDs (2.8 million enrollees) pay at least $50 per month, including 6 percent who pay $100 or more per month, in addition to the monthly Part B premium. The MA-PD premium includes both the cost of Medicare-covered Part A and Part B benefits and Part D prescription drug coverage. Among MA-PD enrollees who pay a premium for their plan, the average premium is $63 per month. Altogether, including those who do not pay a premium, the average MA-PD enrollee pays $25 per month in 2020.

It's Always Something . . . . Roseanna Roseannadanna
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@GailL1  all you and your coach are giving me is a simple slight-of-hand circus smoke and mirrors argument against the Medicare.gov plan finder. You’re not able to invalidate the known and proven facts that the plan finder works in saving millions of senior’s money on their PDP part D prescription drug plans every year. I know I've seen it.

 

You surprised me when you do not encourage folks to learn to use the plan finder. Usually, you try to simplify and educate folks about Medicare and its details.

 

Until you reach that golden age of being Medicare eligible and actually have a part D plan you might not realize the plan finder works fantastic.  

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I'm not saying that the Plan Finder isn't a valuable tool - IT IS.  But only if it is right and for the last few years, because they changed it in 2019, I believe, it has had a lot of problems.

 

I don't know if it is right or wrong currently - the site says that you can preview it now (they uploaded it on 10/01/2021) - but can't enroll until 10/15 - I just urge people to recheck their earlier preview before enrolling.

 

The plus to the PF tool is only as valuable as the information fed into it.  I'm just reserving judgement.

 

 

It's Always Something . . . . Roseanna Roseannadanna
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@GailL1 good analogy . . . apple, orange + watermelon.

 

Some folks don't realize the D in MAPD is still a Part D plan that is baked into the MA health care coverage. Carriers that write MAPD and PDP use the same PBM to pick pharmacy's, set tiers and copay's.

 

Problems in the stand alone PDP will also show up in the MAPD. The only difference is the consumer has no idea how much the D premium is in the MAPD.

 

For next year, MAPD plan premiums may not change but other cost shifting does occur. Higher deductibles, smaller preferred pharmacy networks, shifting tiers and higher copay's.

 

Since a lot of folks never shop the D portion of their MAPD (and most agents don't shop it either) they don't know they have a problem until they use their plan.


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