2010 Medicare Part D Changes

In last weeks article I talked at some length about the changes that would be occurring with the Medicare Advantage Plans for 2010.   This week I will be explaining  changes in the ever popular Medicare Part D programs for 2010.  It is important that you read very carefully any letters or packages you receive from your insurance company.  Check that all your medications are listed in the formulary, and that you understand how the co-pays and deductibles will work. If you need help free assistance is always available from the following people:

  • You can contact Medicare directly at 1-800-633-4227,
  • The local SHIBA folk can be reached at 452-3221 and they hold free clinics at the Sequim Senior Center each Tuesday between 10am ~ Noon
  • Or, call your friendly local insurance agent – Castell Insurance

In addition I find that the www.Medicare.gov web-site to be extremely useful in helping decipher the jungle, for those who are comfortable using a computer.

Many people do not bother to wade through all the fine print, but you should.  If you do not, you may regret it for all of 2010.   For 2010 the number of plans offered in Washington State has dropped slightly to 44, and of this number a couple of plans are not open to new enrollees, but are just allowing their existing clients to keep their coverage if they so choose.  The biggest change I have noticed this year is that the number of plans that are offering programs with zero deductibles has dropped sharply, from 27 plans in 2009, to 16 plans in 2010.  Over 60% of the programs will have deductibles ranging from $50 to $310 in 2010.

The lowest plan available is just $8.80 per month and is offered by First Health and is only available directly from the company, they do not allow insurance agents to assist members in enrolling or dealing with service issues. This plan has worked fine for persons who do not take any medications at all, and just want to be in the Part D program to avoid penalties at a later date.

Another company that shall go unnamed has changed my commission level to the princely sum of $0. When I have shared a copy of the commission schedule with people in my office their reactions have been funny to watch.

The Humana Standard PDP (that is to be replaced) was the plan that was originally only $6.93 when the plans were introduced 4 years ago.  That premium has rapidly climbed to over $30.

The new lower cost plan from Humana the Value plan has a premium of only $18.60 per month, but the formulary or list of covered medications is not as comprehensive. For example it does not cover the cholesterol medication Lipitor. So, if you enrolled because of the low premium and you took Lipitor, you would be stuck paying 100% of the cost of the medication all year.

Talking of Lipitor, I have completed a little research on that one medication on the 42 plans available for 2010. These plans are offered by 17 different companies.  Of  these 17 companies at least 5 of them offer plans that do not cover Lipitor. These 5 companies are Humana, Unicare, Sterling, United American and EnvisionRx.

Let’s go one step further.  By now everyone is aware of how the insurance companies classify medications in different “Tiers”; this is primarily how much your co-pays will be. Consider the following.

Lipitor is as follows with these companies:

  • Humana Enhanced Plan, Tier 2, $45 co-pay
  • Aetna (Costco plan)  Tier 3, $33 co-pay
  • Coventry Premier Plus, Tier 4, $90 co-pay ~ Based upon a percentage of retail
  • Group Health ~ Tiers and co-pays vary depending upon strength of dose

So, you can see the formularies are all completely different as are the co-pays, a Tier 3 with Aetna is less costly than a Tier 2 with Humana.  Things are definitely getting far more complicated as far as tiers and co-pays.

Talking about Tiers, most companies in the past have had 4 basic tiers.  Tier 1 for generics, Tier 2 for preferred brand, Tier 3 for non-preferred brand and finally Tier 4 for speciality drugs.  Many companies now have expanded that to 5 Tiers and in the case of CVS Caremark Plus they even have 6 different Tiers.

In the case of CVS Caremark, they have enhanced benefits if you shop at a CVS drug store or purchase online. They do have one store in the whole State of Washington, and it ain’t on the Peninsula.

Both Humana and Aetna offer plans that have a $0 co-pay if you purchase 90 days supplies via mail order.  Did I say purchase?, how can you purchase something for nothing???

The surprising thing is that the Aetna Plan that offers this tremendous benefit is the Costco branded plan.  The other two Aetna plans do not even give a discount if you order generics via mail order.  So, I wonder if the genius at the Costco Headquarters who signed off on a Costco branded product that actively encourages people NOT to visit the store will find they will be promoted or fired. Any comments??

Castell Insurance will be representing over 50% of the plans available including AARP, Humana, Sterling, Group Health, Aetna and numerous others.  In addition we never charge for our services as all compensation is paid by the companies we represent.

As always at this time of year, I urge people to take care and read all the material you receive from your insurance plans.


Posted on: October 20th, 2009 at 11:14pm by aveadmin12. Filed under: Uncategorized
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