Pick a plan man!
We have a sister website called MedicareDrugPlans.com, where you can find basic information about, well, Medicare drug plans, and read reviews of the plans written by people who have used them, and rate your own plan if you have one. We’ve updated our data to include the plans that will be available in 2017.
Why? It’s that time again to pick a Medicare Part D plan. Doors opened today, October 15, and will close on December 7. If you’re one of 57 million Americans, most of them over 65, who are enrolled in Medicare then you either have a plan or are newly eligible for one. There are many plans (although fewer than there once were) and picking one can be highly aggravating. While online pharmacies, drug prices, and personal drug importation are PharmacyChecker.com’s forte, each year since we started PharmacyCheckerBlog, I’ve tried to write something educational, practical, even funny, about the plans and how to pick one at enrollment time. This year I went nuts. Still, if you read through this post carefully, it will teach you about Part D Medicare drug plans: the good, the bad, and the ugly and give you resources to learn even more. First a very little history… (more…)
Tagged with: Medicare, Medicare Part D, Part D
I’ll keep it real brief today. So far this year, most reviews on our Part D ratings site – MedicareDrugPlans.com – are written by frustrated and angry American seniors who have discovered they will be paying much more money for prescription drugs in 2016. I, happily, concede that there are millions of satisfied seniors who are going about their year with good Part D coverage. For instance, so far my mom is happy (but I helped her pick her plan). Let’s face it: millions of others are not happy and they are rightfully venting. Let us know about your experiences with Medicare Part D this year, by rating and reviewing your plans. Note: We want to hear good reviews (we know some of you are happy with your plans) to help people find the best plans!
For an overview of the venting, check out the reviews below.
Plan: Cigna-HealthSpring Rx Secure – California
Review: This plan was $39 in 2015…increased to $77…I received no notification of the increase, and did not realize it had changed until I received my Jan credit card statement by then it was too late to make a change….I would absolutely not choose this company in the future. Major rip off for senior citizens!
Multiple Medicare Part D Mayhem
Plan: Humana Walmart Rx Plan – South Carolina
Review: Explanations of coverage terrible. They challenged our first two prescriptions although we had been taking them already. Looks like they almost automatically reject prescriptions and force you to get exceptions — wear you down. So far it’s everything bad you’ve heard about insurance companies. And the Wal-Mart guy (pharmacist)? I asked one question: ‘Which of these are tier one and two”. His ‘helpful” response. “I haven’t the faintest idea”
Drug Cost Smack
Plan: Blue MedicareRx Value Plus
Review: i enrolled and used plan for 4 months and then they bumped the cost of an in-office infusion therapy from $40 dollars per treatment, (every 8 weeks), to $862!!!!!!! No notification. Dropped them like a rock and off to MEDEX with separate plan for prescriptions.
Tagged with: Blue MedicareRx Value Plus, Cigna-HealthSpring Rx Secure, Humana Walmart Rx Plan, Medicare Part D, medicaredrugplans.com
Unfortunately, public scrutiny about high drug prices doesn’t usually lead to legislative fixes, such as passing legislation that would allow Medicare to negotiate drug prices with the pharmaceutical industry and expand the practice of safe personal drug importation so more consumers access lower prices from foreign pharmacies. On the other hand, a New York Times article – “Even Talking About Reducing Drug Prices Can Reduce Drug Prices” – suggests, well, that “talking about” drug prices can reduce them, because pharma executives get scared that if they don’t moderate drug prices, more permanent and progressive fixes will finally happen.
Tagged with: Bernie Sanders, Big Pharma, Drug Prices, Hilary Clinton, House Committee on Government and Oversight, Marco Rubio, Martin Shkreli, Medicare Improvement and Modernization Act of 2003, Medicare Part D, New York Times
In this post, we’ll give you some snapshots of consumer frustration, pulled from www.MedicareDrugPlans.com (a website operated by PharmacyChecker.com), about the problem of medications getting dropped from Part D Plans and tell you what is and is not actually permissible. I believe this practice is well characterized by the phrase “bait and switch.” Just listen to Riley from California talk about Blue Shield Medicare Enhanced Plan:
“Keep changing the drugs in the formulary. Just get stabilized on a drug and they drop it from the formulary or charge high tier prices. Then you start on a different drug fine one that works then it is no long covered in next formulary. There is no concern for the patient doesn’t matter to them if you wind in the emergency room at a cost of many thousands of dollars and patient’s pain and discomfort. It is not their problem the medical coverage has to pay for it and the drug coverage have saved themselves some money at the cost of medical coverage, medicare and the patient.”
Before choosing a plan, most experts encourage people to research plan premium and deductible costs, pharmacy networks, gap coverage, and – most importantly – which drugs are covered in a plan’s formulary. The beauty of the government’s Medicare Plan Finder is that you get to actually type in your medications and find plans that cover those drugs. So imagine doing just that: you look on the government’s site and find a plan that covers the three medications you take. You’ve taken THE BAIT and enroll in that plan. Come January all is well, your costs are manageable and you pat yourself on the back for a research job well done. Then in March – THE SWITCH – you find out that the brand name drug prescribed by your doctor, which has worked well for you for years, will no longer be covered and you either have to take an alternative drug that is covered or pay for the drug as an out-of-pocket cost.
Is this type of bait and switch legal? Yes. After reviewing the regulation, 42 CFR 423.120, the law is clear that Part D plan sponsors can take a covered drug off its formulary. There are some caveats but I don’t believe they compensate for how unfair these formulary changes are. The plan must either give you 60 days notification before the formulary change goes into effect or if you go to the pharmacy for a refill the plan must cover the drug with a 60-day supply. In other words, they need to warn you about the bait and switch to give you time to figure out your next move.
Some enrollees seem to have had good experiences with a plan and then everything just tanks. We learn from one Michigan resident about an experience using the Cigna-HealthSpring Rx Secure plan
“After 5 years in plan they dropped coverage on 3 of my 5 scripts, no value now, cheaper to buy all on my own”
Some consumers gave greater details about the costs incurred due to these bait and switch practices. Here’s what one Floridian said about AARP MedicareRx Saver Plus:
“They dropped an important Blood Pressure medication (Micardis) for 2015 as well as others. Out of pocket cost went from 2013 -$60.00, then in 2014 $120.00 now in 2015 over $545.00 for 90 day supplies of Micardis through Optum RX their online med source. Too late for me, will look for a better Part D source come next year.”
Our friend from Florida could look for a new plan for 2016 but what guarantees to they have that the same bait and switch won’t occur?
Is there an upshot here? You do receive notification with 60 days to figure out what to do. The notification that you’ll receive about your drug being dropped must contain, to quote from the federal regulation, “alternative drugs in the same therapeutic category.” It might seem like small consolation if the medication you’ve been using works but do not rule out a pharmaceutical alternative, probably a lesser expensive generic, IF your prescriber believes it will work just as well.
If you and your healthcare provider decide you should take the drug that was dropped and not a pharmaceutical alternative, and the costs are too high domestically, then you might consider an international online pharmacy verified by PharmacyChecker.com. Brand name drugs are often 90% lower outside the U.S. when purchased from a verified online pharmacy.
Finally, there is an appeal process that you and your healthcare provider can use if you believe your plan isn’t covering the medications you need – including ones that they drop! I’ve read that this process can be a serious nightmare. But this is a blog post unto itself and I plan on covering this topic in the weeks to come.
Tagged with: bait and switch, consumer review, formulary changes, Medicare Part D, medicaredrugplans.com
We’re two weeks into the open enrollment period of Part D Medicare Drug Plans and it is my deepest hope that if you are a Medicare enrollee then you are taking time to find the best plan. It’s not easy. Finding the right plan, however, could mean getting the medications you need to stay healthy, saving money, and avoiding lots of headaches throughout the year. Our website, MedicareDrugPlans.com, gives you basic information, such as premiums, deductibles and coverage levels, but also ratings and reviews about Part D plans that can inform you about the experiences of your peers in using the different plans. Your final search should be with the government’s website – Medicare Plan Finder – where you can find the plans that cover the medications you are already taking now and specific costs related to those plans. Below are key points about costs and coverage.
Part D Plan Costs
Plan costs have gone up this year. The deductible cap increased by 12.5%, from $320 to $360. Fifty-three percent of the plans are charging the full deductible, while the other 47% charge less. Average premiums have increased from $36.68 in 2015 to $41.46 in 2016. The lowest monthly premium is $6.80, that’s if you live in Puerto Rico and choose the Humana Preferred Rx Plan. The highest premium is $174.70, that’s if you live in Florida and choose Blue MedicareRx Option 2.
Part D Plan Choices
The overall trend of having fewer Part D plans to choose from continues this enrollment season, down to 886 this year compared to 1001 last year. Looked at historically, the declines are even more striking, as there were 1,875 plans in 2007. These numbers are the totals available in all states and U.S. territories but options are really state-based. Alaskans had only 19 plans to choose from, compared to a high of 29 in West Virginia and Pennsylvania.
Part D Plan Coverages Phases
There are four coverage phases for Part D plans: deductible, initial coverage period, the coverage gap, often referred to as the “donut hole,” and catastrophic coverage. The deductible is pretty straightforward–you pay the full cost of your medications up until that dollar amount, which can be as high as $360. During the initial coverage period, you usually pay about 25% of drug costs and the plan picks up 75% until total costs have reached $3,310. At that point you’re in the coverage gap, but you’re paying discounted prices, 45% and 58% of brand and generic drug costs, respectively. Once total costs have exceeded $7,515, you are in catastrophic coverage territory, and only have to pay 5% of your total drug costs until the next year begins.
Understanding these generalities about Part D plans is important, but the devil is in the details, which can only be understood through research. It’s not enough to just stick with the plan you have. Nine out of 10 Medicare enrollees do not change plans, and many end up with higher drug costs because they don’t. The landscape of plans changes every year; so do your research, shop around, and get the best plan for your health and wallet!
For a thorough plan analysis see Kaiser Family Foundation.
For ratings and reviews, check out www.medicaredrugplans.com.
To finalize your decision go to Medicare Plan Finder.
Tagged with: donut hole, Kaiser Family Foundation, Medicare Drug Plans, Medicare Part D, medicare plan finder, Medicare.gov, medicaredruglans.com