Kevin Knauss: Health, History, Travel, Insurance
Posts on Medicare Part D Prescription Drug plans included in Medicare Advantage or stand alone PDP with Original Medicare and Supplement.
Individuals who recently acquired Parts A and Part B of Original Medicare may find they have to pay more per month than their existing ACA health plans. Under the ACA rules, once someone accepts Medicare, they must exit any ACA health plan they purchased through the exchange and the tax credits that make it affordable. […]
Before you talk to any insurance agent, prescription drug plan call center or sign up for a Part D Prescription (PDP) drug plan from a direct mail advertisement go to Medicare.gov and do a plan comparison. The Medicare prescription drug insurance plans are the most complicated and confusing of all the Medicare decisions a beneficiary must make. The Centers for Medicare and Medicaid Services has built one of the best online comparison tools for evaluating PDPs.
One of the first options a Medicare beneficiary faces when they are reviewing Part D Prescription Drug plans (PDP) is whether they want a plan with a deductible. The deductible amount, set by Medicare, is the dollar amount a plan member must pay before he or she is eligible for the reduced copayment for the drugs. The big decision for the Medicare beneficiary is if they should select a PDP with a lower premium and $310 deductible or pay a higher monthly premium for a no deductible plan.
California Medicare beneficiaries will have over thirty Part D Prescription Drug Plans (PDP) to choose from in 2014. But a recent Kaiser Family Foundation study found that upwards of 80% of individuals never switch their PDP even if new plans offer better coverage and a lower premium.
Thousands of Medicare Advantage plan members in California are receiving letters that their health plans are closing from carriers such as Anthem Blue Cross and Health Net. Some of the health insurance companies will be leaving some counties completely while others will be offering new Medicare Advantage (MA) plans to their members. Regardless of the reasons, the plan closure triggers a Special Enrollment Period for Medicare beneficiaries to select a new plan offered in their county.
Medicare Advantage plans have been encouraged by the Centers for Medicare and Medicaid Services (CMS) to include $0 copay prescription costs for medications that work to reduce heart attacks and strokes in the plans for 2014. Some plans will be including $0 copay drugs that fight high cholesterol and high blood pressure.
Not too long ago the talk in conservative circles was how the cuts to Medicare Advantage plans under the Affordable Care Act would hurt seniors. The Centers for Medicare and Medicaid Services (CMS) has announced that more seniors now have access to higher quality Medicare Advantage plans as there has been a 28% increase in plans receiving four or more quality star ratings for the 2014 open enrollment period beginning on October 15th.
The Affordable Care Act set in motion a series of reforms to slowly close the coverage gap or “donut hole” that Part D members faced after they met their initial coverage dollar amount. Pharmaceutical manufacturers that wanted their Brand name drugs covered in the gap had to sign an agreement with Medicare to cover 50% of the cost of the drug. Medicare has had to assess civil monetary penalties on many companies that failed to cover the discount.
With only one manufacturer of the Shingles Vaccine, Zostavax from Merck, there are no generic prices on the market. The retail price for Zostavax at the local pharmacies I surveyed is fairly consistent across the board. Lower prices can be found under different Medicare Part D Prescription Drug Plans, but even with insurance, there can be a spread of $115 to $170 difference in the cost.
CMS cited numerous failures on the part of SmartD Rx to properly handle member’s prescription drug and enrollment transactions.
