2020 Medicare Open Enrollment: Selecting a Drug Plan (Part D) – Down the Rabbit Hole We Go…
The Medicare Open Enrollment period for 2020 coverage runs from October 15, 2019 to December 7, 2019. During this time, individuals can enroll in Medicare Advantage Plans, Drug Plans (Part D), and Medigap Policies.
My Mom recently received documentation from her insurance company which indicated that her 2019 prescription drug plan would be changing in 2020. As a result, I decided to start looking into alternatives. This is turning out to be a complex process.
Some Calculators Are Black Boxes
First, I used an online calculator and "compare tool" offered by the retiree benefits website sponsored by my Dad's former employer. I entered my Mom's medications and discovered that her existing insurance plan was going to cost over $10,000 a year, between the premiums, the deductible, and the out of pocket drug costs. That seemed crazy, compared to some of the alternatives that were provided. Yet, it wasn't clear from the calculator what accounted for the dramatic differences in price.
I had some theories – I had looked up all my Mom's medications on the existing insurance company's drug formulary to see what "tier" they fell into -- preferred generic, generic, preferred brand, non-preferred brand, or specialty. One of her eye drops and one of her other medications fell into the "preferred brand" category, so I suspected perhaps that was the culprit…
Can You Trust the Insurance Companies' Online Calculators and Information?
Next, I went to Mom's current insurance company's Medicare prescription plan compare tool. On the company's website, it looked like her pharmacy was considered "in network" for 2020. I entered all the medications again into this online tool. This calculator forced me to figure out what "fraction" of a bottle of eye drops Mom used every day. For those who are interested, the standard conversion factor is 1 milliliter of liquid eye medication equates to 20 drops. The insurance company's calculator made it seem like Mom's 2020 costs were going to be more like $2,000 a year.
The Medicare Online Compare Tool – Some Visibility at Last!
Maybe I'm like a dog that won't let go of a bone, but the discrepancy between the retiree benefits website calculator and the insurance company calculator continued to bother me. I then went to the online calculator on the Medicare website. By now, I'd practically memorized Mom's drug list. I entered the information into the site and compared her current insurance company's 2020 plan with a couple of other offerings. Once again, the estimated cost for her current company's 2020 plan was over $10,000. The good thing about the Medicare calculator, however, was that it clearly showed that her current pharmacy was out of network in 2020. I had found the missing link!
I then did an online chat with the existing insurance company to inquire whether the pharmacy was in fact out of network for 2020. The representative confirmed that was the case. Why it shows up in their online search tool for 2020 as "in network" is beyond me. That misinformation could have been very costly, if I'd decided to stick with this same company for Mom's prescription plan in 2020.
The Saga Continues…Next Steps
Now that I have finally determined that staying with the same insurance company isn't a good option, the search begins in earnest to find a better alternative. Some things to consider if you're going through the same process for a family member:
Find out what "tier" your family member's medications fall into. Check the insurance plan's formulary. The tier often determines co-pays, what drug costs go towards deductibles, etc.
Consider building your own Excel model to estimate costs. The online calculators are helpful, but I don't trust the "black box" nature of them. It's relatively easy in a spreadsheet to figure out estimated costs for the year, based on premium payments, deductibles, and estimated drug costs based on drug tiers. Compare your results to the online calculator. If it doesn't pass the "sniff test" dig in a bit more to see what's going on.
Contact the insurance company to confirm that the pharmacy is "in network" for the plan you are considering. Some pharmacies get preferred pricing, while others may be in network but offer only standard pricing. In all cases, mail order is usually the cheapest, but isn't practical for individuals in long-term care facilities.
Good luck out there, if you've also fallen down the Medicare open enrollment rabbit hole. The good news is that we have until December to figure it all out. The bad news is that it may take that long to figure it all out!
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