…Medicare drug plans that is.  How much do you really know about them?  They have been around since 2006, they are in partnership between CMS and private insurance carriers, and they are available to all Medicare beneficiaries enrolled in either Part A &/or Part B.  They are referred to as Part D and are administered by private insurance carriers but regulated by CMS.  The contracts are renewed annually.  There are currently over 30 prescription drug plans available in Lee County.  They range in price from $7.30/month to over $100/month.  These plans are optional, meaning you don’t have to enroll in a plan if you don’t want to, but beware that there may be a Late Enrollment Penalty should you change your mind later.  The penalty amounts to 1% of the national average cost of a drug plan and is payable in addition to the monthly cost of the drug plan you enroll in.  Our agency has some clients that are paying over $40/month in penalty! 

My suggestion is to always take a drug plan even if you don’t take any drugs – just choose the cheapest plan on the market and update your plan annually as your needs change.  Better safe than sorry, and, if you need an expensive drug in the middle of the year, you’ll be glad you have a plan.  Otherwise, you won’t be able to enroll in a plan until the Fall Annual Open Enrollment and the new plan won’t go into effect until January 1st.  Covered by the VA?  Then you are considered to have a qualified drug plan and are exempt from the Late Enrollment Penalty.  Same goes for many employer sponsored plans.

As there are over 30 plans to choose from, how can I ever decide which one to take??  We help you by entering your medication (including dosage info) and pharmacy you will use into our quoting tool.  It will then tell us which plan will be the most economical for you. Each plan has its own formulary, or, list of covered drugs. It will also show which drugs may come with certain restrictions, such as:  Prior Authorizations, Quantity Limits, Step Therapy, if the drug is a Part B or Part D drug, or has a Dispensing Limit or Limited Access.  Most plans put drugs into one of 5 tiers, with Tier one being the lowest cost and Tier five for specialty drugs.  Copays vary by plan.  Many plans will offer you a lower out-of-pocket cost if you will use a preferred pharmacy or mail order.  Some plans are participating in the new government Insurance Senior Saving Program, capping insulin costs at a low $35 copayment and eliminating the initial deductible.  This is a game changer for an insulin dependent diabetic!  You can also get your Part D prescription drug plan as a stand-alone plan or included within a Part C Advantage plan.

When you enroll in a drug plan, you generally agree to keep that drug plan for the balance of the calendar year.  There are exceptions to this, such as:  qualifying for or losing Extra Help; qualifying for or losing Medicaid; entering or leaving a Skilled Nursing Facility; losing or dropping an employer sponsored plan; affected by a FEMA emergency; moving outside the plan’s service area; and others. 

We recommend reviewing your coverage once a year, generally when you receive your Annual Notice of Change in September, mailed at the requirement of CMS.  It will tell you if your plan will have a premium change, if the drug tiers will have a copay cost change, if your drugs will have a tier change, if your drugs will still be covered, and other useful information.  If you are OK with the proposed changes, then you need do nothing as your plan automatically renews.  Should you wish to make a change, then you can contact your agent during the Annual Open Enrollment between October 15th and December 7th.  Your agent can help you make a plan change that fits your needs. 

That was a lot of information!  Looking for an agent to answer your questions?  Let us know.  Call, click or stop in today – you’ll be glad you did.