How do I shop and compare Part D Rx Prescription plans?

Medicare Plan Finder for 2021

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Medicare Part D Shopping Video

How to shop Part D rx plans

Learn more on our webpage about the Shopping Tool along with Q & A or Ask your own question at the bottom of the Q & A section

BE CAREFUL OF THE SNAFU'S!!!

The “Total Yearly Cost of Care” does not provide personalized or transparent information. For example, when a consumer inputs or changes personal data, such as drug information, his or her total estimated costs do not change. This is not mathematically possible based on the plan benefits. Additionally, the tool does not share what is included in the total cost. As a result consumers will likely see the total cost and assume they are receiving a personalized and tailored estimate which may not be accurate.

The estimated total yearly cost of care is flawed. On a plan that has reduced benefits year over year, the expectation would be that the “estimated total yearly costs” would increase. However the tool is inaccurately estimating the consumer’s costs will decrease. It doesn’t make mathematical sense. For consumers on a fixed income and cost conscious, this could be detrimental to their situation.

Most supplemental benefits are not included in the total yearly cost of care. Over the past several years supplemental benefits have expanded and provided members with options that not only treat, but prevent illness and increase quality of life. We know the high value of benefits such as vision, dental and hearing to our consumers, and they are a key way we are partners in care with our members. Some of the benefits that are not included are:

Transportation lists copay but not number of rides.

Eyeglasses list copay but does not share if benefit covers frames, lenses or contacts.

Wellness Programs include a long list of possible items including fitness, nurse hotline, Personal Emergency Response and telehealth, that can’t be lumped into a single “covered” or “not covered” benefit.  Excerpt from UHC Agent Memo  * Forbes GAO 7.2019 Report

The four  main tools to shop and compare Medicare Part D Rx plans are:

Here’s the results of a hypothetical person with
Multiple Sclerosis 

See below and video above for more details on how to work the tools.  If you prefer, you can email us [email protected]om your medication list and we can do the comparisons for you.  We do need you to set up a Social Security Account and send us the password, so that your Rx list gets saved.

rx list of drugs and costs

Scroll down  for definitions and instructions to use the Rx Plan Finder

Research on plans to help those who make too much $$$ for LIS Low Income Subsidy – Extra Help

 

Medicare.Gov Glossary
for Shopping Tool 

Coinsurance

An amount you may be required to pay as your share of the cost for health care services or prescriptions after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

Deductible

The amount you must pay for health care services or prescriptions each year, before your Medicare drug plan, your Medicare Health Plan, or your other insurance begins to pay. These amounts can change every year.

Dosage

The prescribed strength or amount of therapeutic ingredient(s) administered at prescribed intervals.

Drug Coverage

This tells you that a plan offers coverage of prescription drugs.

Drug Restrictions

The plan may have certain coverage restrictions (including quantity limits, prior authorization, and step therapy) on a prescription drug.

Example of Restrictions

Example of Restrictions

Estimated Annual Drug Costs

This is an estimate of the average amount you might expect to pay each year for your prescription drug coverage. This estimate includes the following costs, as applicable:

  • Monthly premiums
  • Annual deductible
  • Drug copayments/coinsurance
  • Drug costs not covered by prescription drug insurance

If you entered your drugs into the Medicare Plan Finder, then this estimate includes the cost of those drugs.

If you selected "I don’t take any drugs," then this amount includes only the cost of the monthly premiums that you would pay for the plan and it does not include any drug costs.

If you selected "I don’t want to add drugs now," then this estimate includes the average drug costs for people with Medicare and may differ depending on your age and health status.

Your expenses may be lower if you have limited income and resources.

Formulary

A list of prescription drugs covered by a prescription drug plan offering prescription drug benefits.

Monthly Premium

The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage. In a few cases, a note will say "Under Review" instead of a premium amount. This means Medicare and the company are still discussing the amount.

MTM Program

Medication Therapy Management (MTM) Programs

offer free services to eligible members of Medicare drug plans. These services help make sure that medications are working to improve their members' health. Members can talk with a pharmacist or other health professional and find out how to get the most benefit from their medications. Members can ask questions about costs, drug reactions, or other problems. Each member gets their own action plan and medication list after the discussion. These can be shared with their doctors or other health care providers. Members who take different medications for more than one health condition may contact their drug plan to see if they're eligible.  Humana * Medicare.gov *

Star Ratings – Medicare Advantage

Medicare Glossary

Medicare Glossary

25 comments on “Shop & Compare Tools Part D Rx

  1. Do you represent any Part D Rx plans that are accepted across the US?

    I’m using the plan finder on the Medicare site above and don’t see any Anthem or Blue Shield plans that are “accepted across the US”

    • I’m not aware of ANY plans from ANY Part D Rx carrier that is Nationwide. This question comes up in our annual mandatory training from AHIP and from each Insurance Company. They use secret meaningless slides that if we show anyone we get our contracts terminated on might be put on the Federal List of people that can’t do biz with the Federal Government, as if we were members of ISIS!

      So, give me a minute to find the answer in the EOC Evidence of Coverage or the Guide to Rx Coverage.

      Where can I fill my prescriptions?

      Each company that offers a Medicare drug plan has a list of pharmacies you can use. If you want to continue filling prescriptions at the same pharmacy you use now, check to see if the pharmacy is on the plan’s list.

      Medicare requires plans to have network pharmacies for you to choose from.

      OK, let’s try the Blue Cross Evidence of Coverage EOC as an example.

      Section 2. Fill your prescription at a network pharmacy or through the plan’s mail-order service
      Section 2.1 To have your prescription covered, use a network pharmacy.
      Section 2.2 Finding network pharmacies
      Section 2.3 Using the plan’s mail-order services.
      Section 2.4 How can you get a long-term supply of drugs?
      Section 2.5 When can you use a pharmacy that is not in the plan’s network?.

      So, download the EOC and the answer is on Page 38

  2. UHC Part D Rx made xxx change from Premarin to Estradiol patches this year. It was good since the copay for the patches is only $10.

    Now it appears that the patches are not in the formulary for 2021.

    Will she have to get a different plan or will we need a doctor to request a dispensation?

    • We are going to need to know which Rx you and your MD prefer.

      I used the Medicare.Gov finder above and the cost if you take both Rx would be $3,650 for Rx & the premium. WOW!!

      Here’s the detailed breakout

      Summary of the 2021 UHC Plans

      First 10 of the lowest 32 plans offered in San Diego (All of CA?) We represent Blue Shield, if you want any of the others, you can get them from Medicare.gov but it would be better IMHO to do it on the Insurance Company website. If there is ever a problem… I think you would have more “juice” there. Blue Shield has a cost of $1,862.

      Here’s the formulary for the 2021 Saver Plus Plan Going by the breakout above, you are right, Estradiol is not on it and Premarin is tier 3.

      Here’s the evidence of coverage for Saver Plus for 2021

      Tier 3 – Preferred Brand – Includes many common brand name drugs, called preferred brands and some higher-cost generic drugs. Page 3 – 8

      Page 3 – 14

      Section 5.3 What can you do if your drug is in a cost-sharing tier you think is too high?

      If your drug is in a cost-sharing tier you think is too high, here are things you can do:

      You can change to another drug

      If your drug is in a cost-sharing tier you think is too high, start by talking with your provider. Perhaps
      there is a different drug in a lower cost-sharing tier that might work just as well for you. You can call Customer Service to ask for a list of covered drugs that treat the same medical condition. This list can help your provider to find a covered drug that might work for you. (Phone numbers for Customer Service are printed on the back cover of this booklet.)

      You can ask for an exception

      You and your provider can ask the plan to make an exception in the cost-sharing tier for the drug
      so that you pay less for it. If your provider says that you have medical reasons that justify asking us
      for an exception, your provider can help you request an exception to the rule
      .

      If you and your provider want to ask for an exception, Chapter 7, Section 5.4 tells what to do. It explains the procedures and deadlines that have been set by Medicare to make sure your request is handled promptly and fairly.

      Drugs in our Specialty Tier are not eligible for this type of exception. We do not lower the cost sharing amount for drugs in this tier.

      Since we quoted BOTH Rx here, the comparison is really meaningless. What Rx do you and your MD really want?

      • I would prefer Estradiol patch .025 twice a week, largely because of the price differential in 2020 plan. But also my PCP prefers it.

        • With CIGNA Secure Rx that would make your yearly drug & premium cost $733. We don’t represent CIGNA.

          We do represent Anthem Blue Cross Medi Blue Rx Enhanced and that yearly cost would be $757.70

          Based on Medicare Publication Guide to Rx Coverage talking about picking coverage that meets your needs, getting help with choices Along with Medicare making the above shopping tool, video’s etc and now with the Rx prepopulating when you use your Medicare and/or Social Security account to log in, I’d have to say, just change plans.

          Please note too, that Medicare is paying 75% of the actual cost of the Part D Rx premium for those singles making less than $85K

          Here’s the link to our Blue Cross Rx page. Just click on the Anthem Logo, it’s our affliate link, so we will be your broker at no additional charge, and enroll. If you need assistance, we can set a Zoom meeting with screen sharing.

          Please note, applications for AEP Annual Election Period are only accepted from October 15th to December 7th.

  3. SUBJECT: Medicare Plan Finder Enhancements for Contract Year 2021

    CMS appreciates your ongoing feedback on the Medicare Plan Finder (MPF). These insights are invaluable as the agency continues down a path of iterative improvements to the tool.

    To assist organizations with preparations for Contract Year (CY) 2021, CMS is providing an overview of enhancements planned for MPF and the related Health Plan Management System (HPMS) modules that support Part D pricing file submissions, plan benefit and drug pricing previews, suppressions and exclusions, and Online Enrollment Center (OEC) management.

    See the link for the full press release https://www.ritterim.com/documents/cy_2021_mpf_hpms_updates_final_05122020.pdf

    Top 10 Q & A
    http://newsmanager.commpartners.com/nahuw/downloads/MPFfaqs.pdf

    Video’s

    Medicare Plan Finder Overview
    https://youtu.be/z71NR-USZ2E

    Pointers – Plan Results
    https://youtu.be/0RPbriAS0UU

    Adding your Prescriptions – Rx List
    https://youtu.be/g4yZyoEFM_k

    • I’m new to Medicare and take several Rx for pain, asthma and a few other conditions.

      I heard that Part D makes one wait 6 months to a year to get coverage for the medications to cover a pre-existing condition.

      So, why should I bother getting coverage?

       

      There is no waiting period or pre-existing condition clause for Medicare Parts A Hospital, B Doctor Visits, C Medicare Advantage, or D Rx.

       

      Medicare Supplements do have a 6 month look back period for Pre X, which is CLEARLY stated in the first paragraph on Page 15 of Publication 02110 Choosing a MediGap Policy.   California is more liberal though!
       
      However, Medicare Parts A & B will still pay. BUT look at paragraph 5, if you buy during a guaranteed issue period, there is no pre-x!

       

      Since you just got Part B you may have a guaranteed issue period for Part D, see publication # 11219 Medicare C & D enrollment periods. We need to get a copy of your Medicare ID card to verify when, why and how you got Part A & B. More on Part A & B enrollment periods.

      I’ve looked at looked and don’t find anything that says exactly that there is no pre – x other than every seminar and training that I’ve ever seen. However, there is NOT a single brochure, policy, evidence of coverage, etc. that says that there is. A pre-existing condition clause would have to be listed in the exclusions and limitations to be enforceable!

       

      Check these links and publications:

       

      CA Health Care Advocates on Part D

      Our introductory page on Part D Rx

      Medicare’s Guide to Prescription Drug Coverage Publication # 11109

      Blue Cross Evidence of Coverage – 124 pages, if this alleged exclusion isn’t here, where could it possibly be?

      While every company has limitations on formulary – what Rx they cover and co-pays for different tiers of Rx, that is not a Pre X clause.

      Here’s a reply from CA Health Care Advocates

      The prohibition against using a pre-existing condition exclusion or waiting period for Medicare Parts A, B, and D is most likely in the Social Security Act that established the Medicare program. Whatever that is would have been applied to Part D when it was enacted if there wasn’t a separate requirement or prohibition.

      But you are right that it isn’t specifically mentioned as a standard feature. Exclusions or limitations in Medicare Advantage programs probably build on that same concept so it probably isn’t specifically mentioned.

      I’ve never looked for it because we know companies can’t impose it as a matter of law on A, B or D.

      I don’t find a pre-x clause in the law Section 1814 Conditions & Limitations

    • Check Enbrel.com for their page on financial assistance. I just ran a comparison on Medicare dot gov, however Enbrel.com probably answers your question better.

      Do you have Medicare?

      77% of prescriptions cost $50 or less per month 1, and the remaining 23% of prescriptions cost an average of $415 per month. 2,3,4,5

      1 A one-month supply of ENBREL is typically 4 weekly 50 mg doses.
      2 These data are based on paid claims data from national data providers for the period 1/1/2018 – 12/31/2018.
      3 Your out-of-pocket costs can vary throughout the year depending on which phase of the Part D benefit you are currently in.
      Medicare Part D drug coverage is divided into four phases, each with a different cost sharing amount. Those phases are

      1) Deductible,
      2) Initial coverage,
      3) Coverage gap,
      4) Catastrophic.

      4 These amounts may vary if you are eligible for the Extra Help program.
      5 Your actual cost may vary depending on your dose and insurance coverage. Talk to your insurance provider for specific information about your prescription coverage. https://www.enbrel.com/support/financial-support

  4. Plan d- I wand to know policy with best coverage as I know you can’t go up once you sign up, you can always lower or change your coverage

  5. I’d Appreciate your assistance recommending Part D plan available.

    Medications to be checked for 2020;

    zydelig 150mg(idelalisib);
    levothyroxine( 100mcg); generic crestor
    40mg(rovasustatin);
    gabapenten 100mg

      • Can you help find the most economic Part D plan for my Medigap, Least premium, deductible, copay and other fees?

        • Yes. See video at the very top of this page, our response just above and you can do the comparison on your own. If you want us to do it, just send a copy of your new Medicare Card, the one with secret #’s, not your Social Security # and we can do it.

          If you do it on your own, we represent Blue Cross, Blue Shield and United Health Care. Let us know and we can enroll you. If you want a company we don’t represent, you can enroll at Medicare.gov or contact that company and ask them to suggest agents in your area.

  6. Medicare‘s plan finder is being upgraded

    https://www.cms.gov/newsroom/press-releases/medicare-plan-finder-gets-upgrade-first-time-decade
    https://www.modernhealthcare.com/medicare/cms-refreshes-much-used-medicare-plan-finder-tool

    The changes include an improved mobile-friendly design

    inform users if a generic version of their prescription drug is available

    Users can also create a personalized drug list and view drug coverage across Medicare Part D plans. If someone is already a Medicare recipient, their recent claims data will be used to prefill a personalized drug list that they can modify based on recent changes in their medical care.

  7. I would like to know what the cost of tier 1 medications are.

    Specifically lisinopril hydrochlorothiazide and Atorvastatin.

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