Medicare Part D

[te1271]

My wife actually starts Medicare today. When she signed up she was on no medication so she picked the cheapest Part D coverage. Two days ago she had a stroke which will require much medication in the future. Is there a grace period and can she change to a better part D plan right now?

[WayneL911009]

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[somarco]

@te1271   https://www.aarp.org/health/medicare-qa-tool/how-often-can-i-change-my-part-d-plan/

[te1271]

Somehow I thought there was a grace period when you first start Medicare that wasn't included in the open enrollment period.

[somarco]

@te1271  Once you choose a Medicare Part D or Medicare Advantage plan during your IEP, then you will not be given an opportunity to choose another plan, even if your health or medication needs change.

https://q1medicare.com/q1group/MedicareAdvantagePartDQA/FAQ.php?faq=What-is-the-Medicare-Part-D-IEP-...

[te1271]

Thanks. I just got a notice that open enrollment starts on Oct 15th. only a little over a month from now. Will I be able to change part D plans then and will they be at the same price they show for the new plan now? For example I now pay $35.50 for the AARP medicare RX SaverPlus. The AARP MedicareRx Preferred Plan that I want to switch to shows $74.80. Does the fact that I am now taking medication change what that premium will be?

[GailL1]

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@te1271 wrote:

Thanks. I just got a notice that open enrollment starts on Oct 15th. only a little over a month from now. Will I be able to change part D plans then and will they be at the same price they show for the new plan now? For example I now pay $35.50 for the AARP medicare RX SaverPlus. The AARP MedicareRx Preferred Plan that I want to switch to shows $74.80. Does the fact that I am now taking medication change what that premium will be?

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Just for clarity - Open enrollment will be for a Med D plan that starts January 2020.

Plan details will be available when they come out by 10/15/2019- lots could change - premiums, deductibles, formulary, copays -

Sounds like you need some help with how Medicare Part D works and finding the right plan for yourself (or wife) - these are individual plans. 

Just some BASIC highlights:

• Plans are set up by area of the country - zip code
• Med D plans can be free-standing or part of a Medicare Advantage plan. 
• Each plan covers a selection of medication in different medication classes.  In (5) classes of Meds, they cover all of them.  Each med they cover is listed on their formulary.
• each medication has a tier - the lower the tier number, the cheaper
• each medication may have some other qualifiers - like PA (prior authorization) or QL (quantity limits), etc.
• most all plans give a pharmacy-type choice that give some savings from more to less - mail order, preferred pharmacies

Medicare.gov - Medicare Plan Finder

I am not goinna get into how the deductible, donut hole, catastrophiccoverage works - you can read about that in the plans which you are considering. 

FOR now -

 - make sure that your wife's doctor is ordering the medication best for her and her pocketbook since you may not have coverage for it.  Tall him your situation - there maybe something cheaper that will do the same thing, if that be the case.

- if you are paying out of pocket - find the cheapest route - GoodRx might be a good source to check

- your current plan might give a pharmacy source that gives you a better price - check her plan.

If you still remain confused, you may need some additional help -

 A local independent Medicare insurance specialist (am I right here, somarco?)

SHIP vounteer (good/better/best here) - Medicare.gov - Find a contact

Remember you can change a Medicare Part D plan and/or a Medicare Advantage plan EVERY YEAR during open enrollment based on need.

This is purely hitting the highlights - Read your plan.

[te1271]

This is the letter I received about the open enrollment. It clearly says open enrollment starts on Oct 15.

[GailL1]

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@te1271 wrote:

This is the letter I received about the open enrollment. It clearly says open enrollment starts on Oct 15.

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Medicare.gov - Joining a health or drug plan

from the link ~  It happens EVERY YEAR for these type plans

During certain times each year (yearly enrollment periods for Part C & Part D)

Each year, you can make changes to your Medicare Advantage or Medicare prescription drug coverage for the following year. There are 2 separate enrollment periods each year:

Open Enrollment Period for Medicare Advantage or Medicare Prescription Drug coverage

What can I do?

• Change from Original Medicare to a Medicare Advantage Plan.
• Change from a Medicare Advantage Plan back to Original Medicare.
• Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
• Switch from a Medicare Advantage Plan that doesn't offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
• Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn't offer drug coverage.
• Join a Medicare Prescription Drug Plan.
• Switch from one Medicare drug plan to another Medicare drug plan.
• Drop your Medicare prescription drug coverage completely.

When?

October 15–December 7

You do not have to stay with the same insurer from year to year - If you have an all inclusive Medicare Advantage plan which includes the Prescription Drug coverage then you will have to change both to separate them or pick another combined plan with the meds on the formulary.

You asked earlier if there was any exceptions when you 1st sign up -

These are the only special enrollment situation - I didn't see any that might apply to your wife.

Medicare.gov - Special circumstances (Special Enrollment Periods)

You can also file for an exception with the current Medicare Part D insurer with the doctor's help.

Here are the specifics - no easy but maybe doable with the doctors help.  Read your current plan.

Medicare.gov - Medicare Prescription Drug Coverage Appeals

[te1271]

OK. The issue is when she signed up for Part A, B,G and part D three months ago she was on no medications and was never on any medications at any time in her life so she went with a cheaper plan like it was suggested on the Part D site. 2 days before her medicare kicked in (she was on an employer plan until 65) she had a stroke that will now require her to take plenty of mrdications for the forseeable future. I guess she can't change that now. I will wait until Oct 15 and ,like the letter says, attempt to enroll her in the more inclusive part D plan. If the letter from United Healthcare is correct I will be successful if not I guess I will have to wait until January.

[GailL1]

@te1271 

She will enroll in the 2020 plan of her choice anytime between 10/15/ 2019 - 12/07/2019 for a plan that begins in 2020.  DO NOT WAIT UNTIL JANUARY becasue you will miss the Open Enrollment period!!!!!

From your UHC letter: 

Just make sure that whatever plan is picked for her by you or her has the meds that she is taking on their 2020 formulary at the best price for your area.  Since she has a free-standing plan D, use the Medicare plan finder site with your zip code.  It will then ask about the medications, the dosage, and the frequency - you will enter each one specifically and then it will give you a list of the insurers in the area and a comparison of their plan(s) with the tier of the drug, deductible, if any, and other specifics.

OR you can see an independent Medicare insurance specialist that can help you sort through all of this - You will have to review this every year to get the best plan and value.

This article was written in 2018 for 2019 plans but just change the dates to 2020 plans and it is good to go for this year.  You only have to pay attention to the Part D or Medicare Prescription Drug coverage if she already had her selection for her Medicare Supplemental plan (Medigap - Plan G)

CNBC 11/18/2018 - What Your Medicare Agent Should Do For You

[somarco]

@te1271 @GailL1 

, you may need some additional help -

 A local independent Medicare insurance specialist (am I right here, somarco?)

SHIP vounteer (good/better/best here) - Medicare.gov - Find a contact

Remember you can change a Medicare Part D plan and/or a Medicare Advantage plan EVERY YEAR during open enrollment based on need.

Yes, open enrollment starts on Oct 15 and ends Dec 7. You can change plans during that time. Your new plan starts 1/1/2020.

Unfortunately the current plan finder will be deprecated and sunsets on the last day of September. Any data "stored" there will no longer be accessible.

The new plan finder is available now and will be the ONLY ONE as of Oct 1.

Anyone who is enlisted to help will either need to input all your drug information manually . . . a time consuming process if you have a number of meds. Any changes you want to make in your drugs after the fact requires starting all over again with entering ALL your drugs and pertinent information.

You cannot save work in progress and return to it later.

The ONLY way to save your work is to register with the NEW plan finder and use the same login information used for MyMedicare.

Volunteers, agents, friends, relatives should NOT be given this information. If you do give it to them that information is NOT to be stored anywhere. Doing so is a HIPAA violation.

Anyone who can access your drug information on plan finder can also view and retrieve all your MyMedicare information. This includes:

Your name as it appears on your Medicare card

Your address

Your Medicare claim number

List of all medical claims filed with medicare for the last 36 months

List of all drug claims paid by your drug plan 

Name(s) of your provider(s) along with address and phone

Name(s) of your primary and secondary insurance plans including policy number

Anyone with login info including access to your Blue Button can retrieve this information.

Login does not have or require 2FA or MFA to verify your identity

Because of the additional time involved to input your drug  information many agents will not be reviewing drug plans this year for clients. The liability of having access to your plan finder/my medicare login is a professional hazard and few will want to go that route.

The new plan finder no longer shows when you have satisfied your plan deductible,enter the donut hole, enter the catastrophic phase. You will not see illustrative monthly copay's as in the past.

Preferred pharmacy's can not be viewed until AFTER you have selected a plan.

Essentially the new plan finder is useless if you want to find plans with the lowest total cost.

[te1271]

Thanks that clears things up. I am the only one who has my log in information and don't plan on sharing that with anyone so that's not a concern. I do have a selected plan right now and it's the middle one of the 3 part D plans offered in my area with AARP. I am considering changing that to the top plan which is about twice the monthly premium I am  paying now. I will have a better picture of my drug costs in the next few weeks so I might not make a change. My suppliment is plan G and I'm not planning on changing that for sure. It it amazing the new plan finder doesn't let you find a plan with the lowest total cost. Not showing deductable information is crazy. How are you supposed to budget for that?

[somarco]

If you don't plan on changing to a carrier other than UHC/AARP you have no need for the Plan Finder. With the occasional exception of the co-branded Walmart plan, I have not found the UHC plans in my state to be cost effective. Most of my clients would rather take a beating than shop at WM.

Picking a drug plan based on carrier name, premium (without consideration for copay's) or deductible is generally not advisable unless you have $$$ to burn. The ONLY way to compare multiple plans WAS the Medicare Plan Finder.

Now it is essentially useless.

If you are committed to one carrier only, they SHOULD be able to run reports on THEIR plans only and give you cost information. You will need to provide them with your Rx info, zip and county.

If you did want to take the 2020 PF out for a spin you can do so by calling 1 800 MEDICARE and talking to the General Dynamics CSR's there. They can access your Rx history without requiring you to give your login information.

Pretty creepy, right?

Even still they will face the same challenges as everyone else. No real useful information in picking a 2020 drug plan.

This may be the year everyone stays with the same plan for next year. The challenge there is about 75% of folks will pay more than necessary for their plan even if there is no change in their meds.

Of those who regularly shopped their plan every year about 3/4 changed plans, pharmacy's or both. Average savings about $50/mo for those taking 3 or more medications.

[te1271]

My two pharmacy's ShpoRite and CVS are across the street from each other and 3 miles from my house. My plan works with both. I wouldn't pick a plan that only works with Walmart just for the fact that it's a 7 mile trip each way.