Changes to Part D plans come in different forms: a higher monthly premium; drugs being dropped from coverage; brand drugs being moved to a higher tier with a much higher co-pay.

This weekend I was checking on Part D plans for the husband of one of my clients.  He takes Exforge, and I discovered that not all plans cover this drug.  I emailed my client, the wife, to inform her that the Part D plan she has does not cover Exforge. Rather than email me, she called me up to say that she takes Exforge and it is covered by her plan.  Hmmm…

Note:  Because I am an insurance broker, I am not allowed to name names, lest someone think I am promoting a plan or plans.

I used the Medicare.gov Plan Finder to look at 2012 coverage, so I went back and looked at information for 2011…  and I saw that Exforge is covered this year by my client’s plan.  Then I went to the website for her Part D plan and typed in Exforge to see if it is covered for 2012.  I found that it is not covered in 2012. Just to be sure, I called the 800 number on the website and talked to a company representative who told me that Exforge is covered this year but not next year.

My client was surprised to learn about this important change in her plan, one of the most popular Part D plans (in terms of enrollment). I don’t know if she was informed of this change.  It might have been included in the materials all Part D and Medicare Advantage plans are required to send to each enrollee in September. Most people do not read the Annual Notice of Change that informs them of changes for the coming year. So we stumbled onto very important information that will require my client to switch to another Part D plan so she can continue to take Exforge.

11/13/11 UPATE: I was looking for information on the AARP Medicare Rx Part d plan, I found the following information on one one of their web pages. It tells me that everyone does get information about changes to their plans – if they read it.

2012 Formulary Changes
If you’re a continuing member in the plan, you’ll receive an Annual Notice of Changes (ANOC). You may notice that a formulary medication you are currently taking is either not on the upcoming year’s formulary or its cost-sharing or coverage is limited in the upcoming year. If your drug has been removed from the formulary or has a new requirement and limit that you must follow, the plan will send you a separate communication to notify you.

CHANGES I’VE DISCOVERED

I’ve already written about the Part D plan that is going from $33 per month to $71.

One Medicare Advantage plan is moving Lipitor from tier 2 to tier 3 with a $95 co-pay.  It has always been a tier 2 drug with a $42 co-pay.  Lipitor is going  generic later this year, so that may be why the company is raising the co-pay for this drug.

The lesson here is that your Part D plan, whether it is a stand-alone plan or part of a Medicare Advantage plan, might be changing. And you need to be sure your brand drugs are still covered, or are not going to double in price. And I’m not sure anybody needs to pay $71 for a Part D plan that doesn’t even cover all drugs.

WHAT TO DO

For people who are comfortable with the internet, this information can be found on-line – though some company websites are easy to navigate while others are pretty challenging.  If you are not computer savvy, you can call the phone number for customer service/member services on the back of your Part D or Medicare Advantage id card.  Ask the customer service rep to tell you what your co-pay will be for your brand drugs in 2012.

Remember: If you snooze you lose. Don’t wait to discover these changes in January when it will be too late to change your Part D plan or your Medicare Advantage plan.  You can fill out the forms to change your plan up until December 7th.  Your new plan would take effect on January 1.

If you want to know more about Medicare, Medicare Part D, Medicare Advantage, who qualifies for Extra Help, and much more…. click the image below.

The phone is ringing and there are lots of people to see. Many of them are current clients who think they might want to change their Part D plan or their Medicare Advantage plan. Some definitely need to make a change.

Comparing Plans

One client, Nancy, was thinking of changing to the Medicare Advantage plan in which her husband is enrolled, so we compared her plan and his plan benefit by benefit.

It turns out Nancy’s plan MOOP is going way up in 2012.  The MOOP is the Maximum-Out-Of-Pocket she would pay each year in co-pays for Medicare-covered services. The MOOP is particularly important when people are treated for cancer, because radiation and chemo therapy have a 20% co-pay in every Medicare Advantage plan. And that 20% quickly adds up to five thousand dollars or even ten thousand dollars.  So the lower the MOOP, the better the financial protection for people enrolled in Medicare Advantage plans. The plan Nancy was considering has a lower MOOP,  but otherwise looked pretty comparable to her plan.

But when we got to diagnostic tests, we saw that the two plans are very different. Nancy’s plan covers many diagnostic tests for $0 co-pay, while her husband’s plan charges 20% per test. Nancy is going to get a series of tests early next year, but she is generally very healthy.  After some thought, she decided she should stay with her current plan.

Doctors not in the network

I met with a man who, last spring, changed to a Medicare Advantage plan with low co-pays and a low MOOP. But after a few months in the plan, he was surprised to discover that most of his doctors are not contracted with the plan. His primary doctor is in the network, but not his urologist, his dermatologist, or his opthalmologist.  Just some minor details that were overlooked by the agent who signed him up!

Part D plan changes

I have previously written about a Part D plan in which I enrolled a few people two years ago, when the premium was just $25.00 per month. It had gone up to $36 for 2011, and it will go up to over $71.00 for 2012!!  The plan is under the Unicare name. I name this plan because only one of my clients actually read the Annual Notice of Change (which everybody receives). I’ve gotten hold of  my other clients who are enrolled in this plan, and they had no clue about the outrageous premium increase.

The problem with Part D is that plans can change drastically from year to year.  And I would say that a majority of seniors do not read the materials they receive from their Part D plan.  But if they miss the Open Enrollment Period (October 15 – December 7) when they can change to another plan, they will be stuck paying an outrageous amount of money in 2012, because Medicare will say, “Too bad you weren’t paying attention”, or “You snooze, you lose”.

I looked up Part D drug plans for Arizona on Medicare.gov to find out how many stars they get. For 2012, there will be 30 Part D plans available in Arizona, and most of them get 2.5 or 3 stars, which is average. The star ratings go from 1 to 5, five being the best.

Only one Part D plan in Arizona gets 4 stars. This plan costs $47.20 per month and has a $320 deductible.  I don’t know if this 4-star plan is worth $47.20 per month when you can get a 3-star plan with the same deductible for $15.80.

The $320 deductible means you pay the first $320 of your drug costs, and then the plan kicks in.

To compare plans, I put two drugs into the Medicare.gov Plan Finder:  Crestor and Proventil HFA.   The $15.80 plan covers Crestor for 20% of the retail cost of the drug after the deductible is met. So, once the $320 deductible is paid (after two months), the cost of Crestor would be $27.20.  This plan doesn’t cover Proventil (which costs $57).

Most of the plans do not cover the Proventil inhaler. Most cover Crestor for a $45 co-pay (plans with a deductible and plans without). Only a couple of plans cover Proventil for a $27 co-pay.

The 4-star plan didn’t have any information on what its co-pays are, or what the drugs I entered would cost, so I can’t say if it’s worth $47.20 per month.

My conclusion is that 4 stars vs 3 stars is not a big deal. The key is:  Which plan covers your drugs at the lowest overall cost for the year?  The Medicare.gov Plan Finder will give you that info, but you need to figure out where to find it.

And I will say once again….”Why are there so many Part D plans? Why does it have to be so complicated? Is it saving Medicare money?”

Insurance companies manage Part D plans and negotiate prices with drug companies, but Medicare pays the bills – to the tune of $78 billion in 2010!!

Part D really bugs me because it is so complicated – and plans change each year. One of my clients called me to say her $25 plan premium is going to $71 for 2012.  I have left messages for two other clients who are enrolled in that plan, which seemed like a good deal two years ago.

Medicare handed Part D over to insurance companies and made it ridiculously complicated.  Why? Why? Why?

PS:  I know why.