GA Medicare Digest

Published: Mon, 09/21/20

Medicare Drug Plans and More - Open Enrollment 2021

Medicare Open Enrollment for plan year 2021 starts October 15, 2020. Many changes are hinted to be coming. Strap yourself in and be prepared to ride.

The Donut Hole Bite

The mystical Donut Hole (Coverage Gap in Medicare lingo) will increase from $6350 in 2020 to $6550 in 2021.

Lot’s of folks talk about it. And worry about it. Truth is MOST Medicare beneficiaries never enter the Coverage Gap.

At least 10 percent of beneficiaries, (about 4,500,000 in 2019) typically hit the coverage gap, according to data from the Centers for Medicare and Medicaid Services (CMS).

The survey asked participants about their average out-of-pocket spending on Part D prescription drugs in 2018. Forty-nine percent said they spent less than $50 per month. Of those who spent more:

35 percent spent from $51 to $250 per month

8 percent spent from $251-$420 per month and

8 percent spent more than $420 per month

“Most people only notice the amount of their prescription co-pay or co-insurance and don’t pay attention to the ‘list price’ of the drug,” Johnson notes. “It’s the list price of the drug— the amount that both the beneficiary and the drug plan pay— that determines how quickly an individual enters the Part D coverage gap,” Johnson explains. - Seniors League

Needless to say, Part D plans are confusing. Some even think they were designed that way on purpose.

Discount Drug Cards Illegal?

Some are under the impression it is illegal to use (or even possess) a discount drug card. Do they really think CMS has “narcs” looking for little old ladies (and men) who are using GoodRx? Will you be handcuffed and hauled off to CMS jail?

Actually you are allowed to use a discount drug card, OR your Medicare PDP card, but not both.

Always be a wise shopper. Compare pricing on NEW and existing prescription drugs. If paying cash saves money vs using your Part D plan, then by all means whip out your GoodRx and pay cash.

You can also use your discount plan at any time, including while you are in the donut hole.

It is unlikely you will reap any discount savings while in the donut hole. Seniors who enter the donut hole pay 25% of the retail cost of the drug. This includes generic AND brand name.

Discount plans like GoodRx only work with generic drugs.

Are ALL Drugs Discounted in the Donut Hole?

Nope.

Drugs on your plan formulary are discounted by 75%.

Non-formulary drugs, and drugs EXCLUDED from Part D, are not discounted.

Nice try.

Can Brand Name Drugs be Dropped From the Plan

In most cases, if your BRAND NAME drug is dropped from the plan formulary your plan will continue to cover it through the end of the year.

But if your brand name drug becomes available as a generic don’t be surprised if your plan will no longer cover the brand name.

Your drug can also be dropped if there is a product recall.

Medicare does not require your Plan to notify you if a brand name drug is being replaced by a generic. However many plans WILL send a courtesy notice of change.

Isn’t that special?

Closing Thoughts

No video this time. Rachel decided to retire rather than return to school. Things have been hectic trying to get everything in place. A process that normally takes place over a few months was accelerated and condensed to a little over 3 weeks.

Like most of us, we have stayed inside and avoided crowds as much as possible. She has been working from home since early March through the end of the school year. Between budget cuts and COVID she opted to leave (mostly) on her terms.

But in the midst of all this craziness there are a few rays of sunshine. One of my clients sent a heartfelt email a few days ago and I decided to share it with you.

Rather than posting the redacted message, I am linking to a blogpost where it was published.

Someday Your Health Will Change

Names have been changed to protect the innocent . . .

Stay safe and wear a mask!

Be well!

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