Question for Gail1 on changing Plan D

[retiredtraveler]

I'm on a very expensive cancer med. I have UHC (AARP) Plan D. It appears I can get a better price from another carrier, such as BC/BS. I would have to do more shopping around, online, to check.

  Question: When enrollment rolls around again, will another carrier take me on with a pre-existing condition, knowing that the cancer med is very expensive?  Or, am I 'locked in' at this point. Of course, I didn't know I would get this condition, so I wasn't looking at cancer drugs when deciding on a Plan D. 

Thank you.

[GailL1]

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@retiredtraveler wrote:

I'm on a very expensive cancer med. I have UHC (AARP) Plan D. It appears I can get a better price from another carrier, such as BC/BS. I would have to do more shopping around, online, to check.

  Question: When enrollment rolls around again, will another carrier take me on with a pre-existing condition, knowing that the cancer med is very expensive?  Or, am I 'locked in' at this point. Of course, I didn't know I would get this condition, so I wasn't looking at cancer drugs when deciding on a Plan D. 

Thank you.

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Sorry to hear about this - wondered where you were.

Do you have a Medicare Advantage plan with the embedded Prescription Drug plan (MAPD)?  Because if you do - there is enrollment up to March 31, 2019 - See the Medicare and You Book 2019, page 65 - it is marked "NEW"

If you have traditional Medicare with a stand alone Part D (PDP) - you will have to wait until open enrollment in the fall of next year (* see note below) but you do not have to worry about any expensive drug you are taking - you just pick the best plan based on your meds at the time, as long as you are in the service area of the insurance provider.  You are not stuck with any of them based on any pre-existing condition.

The thing is with oral cancer treatment meds - your oncologist might decide to change them if he/she thinks one isn't working too well based on your body marker studies but yours might find the best one right off the bat -

If you are on a Part D plan and the oncologist orders something not on the formulary ( I think most are on all with various decgrees of cost) - there is always the "exception" route which the doc has to help you with filing - Most likely this would be for some really new med recently approved. 

IV chemo treatments are currently paid under Part B - not D.

Open Enrollment for MA and Prescription Drug Coverage is October 15–December 7 each year. Your changes will take effect on January 1 of the following year, as long as the plan gets your request before December 7.

* However, if the plan that you want now has a 5-star rating, there is a 5-star special enrollment period if applicable.  Medicare.gov - 5-star special enrollment period

This is also covered in the Medicare and You Handbook at the other link on page 74.  In fact, review all of Section 6 - Medicare Prescription Drug coverage (Part D) in the 2019 Handbook.

The 5 - Star Switch    (from the Medicare links)

• You can only switch to a 5-star Medicare Prescription Drug Plan if one is available in your area.
• You can only use this Special Enrollment Period once during the timeframe below.

Note

You can switch to these plans once from December 8–November 30:

• A 5-star Medicare Advantage Plan
• A 5-star Medicare Cost Plan
• A 5-star Medicare Prescription Drug Plan

BTW - somarco is a professional Medicare plan broker but not where you live - he is VERY knowledgeable about the Medicare rules and stuff.  So I am hoping that if he has anything to add or subtract from my reply, he will.

I will turn on my PM.  I will be thinking about you as you continue on this journey.

[somarco]

Reiterating, medical underwriting is not required when changing DRUG plans (Part D). Only when changing Medigap plans in most areas. Limited underwriting is required when seeking a new MA plan.

In addition to the SEP's listed above there are a few more that could apply.

• You have or lose Extra Help.
• You are admitted into or reside in a qualifying institution.
• You enroll in an All-inclusive Care for the Elderly (PACE) program.
• You become eligible for a Special Needs Plan (SNP).

Note: After the first 60 days of the year, a Part D plan can make changes to its formulary. If any of your drugs are removed from the formulary through such a mid-year change, your plan should continue to cover the drug for you until the end of the calendar year unless there are safety issues or there is a generic form of your drug. You do not get an SEP if your plan stops covering a drug you need.

https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/medicare-...

[retiredtraveler]

Thank you for the responses. I have the 'traditional' Part D (not Advantage) through United Healthcare. So, I'll wait and see if I am going to continue the expensive med beyond this year, and shop around. It's possible I can get a grant from one of the foundations to cover a great deal of the expense. It would be close --- I'm not poor and unsure if I'll qualify. But, I'll submit the forms and see.

Thanks again.