It seems like not a year goes by without some major shakeup regarding either Medicare advantage or Medicare Part D Prescription (PDP) plans. This year we have changes on steroids.
The first headache agents and other senior volunteers will be facing this fall is that the Center for Medicare and Medicaid Services (CMS) is changing its Prescription Drug finder (PDF) on Medicare.gov. For years we have had the ability to create a “Drug List ID.” This gave us a unique ten-digit ID number and the date of our search and the option to save our list. It has been an invaluable tool for us.
Let’s say Betty Rubble takes ten meds. Also, let’s say that last fall during the Annual Election Period (AEP from Oct. 15 through Dec. 7) I pulled up her previous list. Betty told me that she dropped one of her meds and added a new one. I would not have to reenter all of her ten meds. I’d simply recall the saved list by populating the fields for the drug list ID and the date of our original search.
Voila, the list of her ten meds pulls up. we delete the one med she has discontinued and add her new one. We enter her preferred pharmacy and hit “Continue to Plan Results.” The website sorts the PDPs in order of the best buys. By best buy we mean the estimated annual cost.
This estimated annual cost includes and is the sum of the following:
- The monthly premium times 12.
- The deductible if there is one.
- The copay for her meds before and after the deductible.
- Her costs when she is in the coverage gap (if applicable).
- Her catastrophic costs once she has moved out of the coverage gap (if applicable).
There have been a few minor traps that a new user could fall into when using the PDF, but a knowledgeable person knew what they were. In short order we advised our clients which PDP that would be their best buy for the upcoming year. One exception for not chasing the lowest cost plan was a PDP with a sub-standard rating. Another exception has been a company known for poor customer service. Other than that, we’d recommend the plan that was the best buy.
Some plans compensate the agents and others don’t. We’d have recommended to you to the most cost-effective PDP irrespective of whether or not the plan compensates agents. Also, there is no incentive for an agent to “churn” people from one plan to another. CMS does not allow any additional compensation for doing this.
We’re happy to provide this service for our clients and we will continue to do so. However, we’re entering uncharted territory this year because of the changes that CMS has made to the prescription drug finder (PDF) on Medicare.gov.
First, our saved drug list will not carry over to the new PDF. That means the hundreds of saved lists are going POOF! Gone!
Medicare wants you to set up a My Medicare account. You enter your date of birth, your Medicare number and create a username and password. So far, the PDF does not give a simple list of the best to the worst buys. It uses a different format for comparing plans. Our experience is that it sorts by premium or copays. Thus, the user has to enter different sort criteria.
The new PDF may be easier for you the consumer to navigate, but it appears to be far less friendly to agents and senior volunteers that do multiple searches per day. You can spend an evening to get set up for yourself, but we’re simply not going to have the time to help everyone set up his/her My Medicare.
Complaints about the new revised PDF have been flooding into CMS, so we don’t know exactly how their new revised PDF is going to play out. There may be more revisions by October 1st.
What’s really irritating about this is CMS’s timing. They wait until the busiest time of the year to foist their new change onto the public. If they would have chosen April, for example, we’d have six months to learn and understand their new website prior to the October AEP. They would have had six months to work out the bugs.
There is some good news here. There is a private prescription drug plan finder that will be available for agents but not for the public. We’ll still have to input your meds, but at least we’ll have a program that will assist us in making the most suitable recommendation for you. We’ll know more as we use this new PDF.
Big Prescription Plan Changes
CMS puts a gag on revealing specific plan information prior to October 1st. By this we mean premiums and specific benefits. However, we can provide you some generalities prior to October 1st.
For several years Humana has sponsored three PDPs. They have been as follows:
- Humana Enhanced PDP
- Humana Preferred PDP
- Humana Walmart PDP
Humana is scrapping those three plans and creating three NEW plans. They are as follows:
- Humana Premier PDP
- Humana Basic PDP
- Walmart Value PDP
The Premier plan will have the highest premium. The Humana Basic plan is intended for those on Extra Help from Medicare. (Extra Help is a federal program that subsidizes some or all of a beneficiary’s PDP premium and provides for lower cost copays. Qualification is based in income and assets or resources.)
The new Walmart Value plan will be the budget plan and will compete in the arena of lowest premium plans.
If you do nothing, here is what will happen in 2020. The people in the current Enhanced plan will be moved to the Premier Plan. Those with the Humana Preferred plan will be moved to the new Humana Basic plan. So far, so good.
Attention for those that have the current Humana Walmart plan.
The Humana Walmart members: If you do nothing, will be moved to the Humana Premier plan. You will NOT be automatically be moved to the new Walmart Value plan. Humana will be announcing this in your Annual Notice of Change (ANOC) letter that you’ll be receiving (if not already) from Humana. You may even receive a phone call from a Humana representative regarding this situation.
We will be contacting you as fast as possible to guide you into the most cost-effective plan for 2020. Please be patient, as we cannot service hundreds of people the first day, but we will get to you during the AEP. Also, please feel free to contact us, and we’ll put you on our list.
Aetna and WellCare
CVS bought Aetna, and the merger is complete. One of the obstacles prior to this merger was the concern by the regulators that CVS would have too strong of an influence regarding PDPs. CVS sponsors the Silver Script PDPs. So, to keep the regulators satisfied, Aetna sold off its PDP unit to WellCare. A few of you have already contacted us about the somewhat vague letter from WellCare explaining this situation.
Be sure to read the ANOC that you’ll be receiving from WellCare. Please contact us with any questions.
We really appreciate the large numbers of you that have previously used PDPHelper.com as a method of submitting to us a list of your meds. Please continue to do so for this coming AEP. Our website is not affected by the changes on Medicare.gov.
Lastly, thank you for your continued business. It is your patronage that keeps us operating.