In California there are 32 different Part D plans offered by 11 different insurance companies. One plan sponsor offers six different plans. The only thing that differentiates these plans at first glance are the marketing names like Basic, Choice, Classic, Enhanced, Plus, Saver, Secure, and Value. These monikers are marketing gimmicks and tell the Medicare beneficiary nothing about the benefits of the plan.
Kaiser is unique in that because they manage their own pharmacies, we can get a look at the ordering habits of opioids, and by extension, the prescribing of those opioids by Kaiser doctors. With a pharmacy like Costco, that has a higher ordering rate for higher strength doses of hydrocodone, it is hard to pinpoint which doctors or medical groups are prescribing the stronger drugs. It may not even be a doctor in Sacramento County.
By paying for prescription drugs out-of-pocket, and not having them accumulate toward the maximum out-of-pocket amount for the health plan member helps the insurance company, not the consumer. Not having the drug costs go through the health plan could cost the consumer thousands of extra dollars in health care expenses because they did not meet their maximum out-of-pocket amount for the year.
If you reside in any of the above counties you will be able to keep your EPO plan. If you reside in any other county, and you have an Anthem Blue Cross EPO or HMO plan, through Covered California or off-exchange, you will need to select a new insurance carrier for 2018. The exit of Blue Cross from the individual and family market does not affect employer group health insurance plans or their Medicare Advantage plans.
I have no problem with these pharmacies running online porn shops. But if they can give the retail price for dildos, vibrators, and prostate massagers, you would think they could advertise their retail price for Abilify, Advair Diskus, Enbrel, Humira, Lantus Solostar, Remicade, or Sovaldi. These are some of the top selling brand name drugs people rely on every day to maintain their health.
This high level overview and will not address every situation that a Medicare beneficiary may find them self in. This short primer is meant help you understand the different parts of Medicare and how they work, or don’t work, together. The following information can also be found in the Medicare and You Handbook.
Before I start gathering coverage information, I create a table with preferred or “must have” providers, hospitals, and drugs in rows, with the available health plans across the top columns. I then mark which health plan has the providers in-network and if the drugs are covered and at which Tier.
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.
When Covered California decided to force health insurance companies to cancel their policies on December 31, 2013, they set in motion a cascading effect that have left many new plan members without access to prescription drug coverage. At least two pharmacies have recognized the problem and are offering help to cover vital prescription medications to new Affordable Care Act health plan members that have yet to received neither member ID numbers nor an invoice.
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.