Annual Election Period (AEP) News

The 2023 Annual Election Period

Hi Everyone,

The 2023 Annual Election Period (AEP) or also know as Medicare Open Enrollment is here. It runs from October 15 through December 7.

New Legislation

The recent “Inflation Reduction Act” legislation passed by Congress has two components that will affect Part D Prescription Drug plans or PDPs for short. This also includes Medicare advantage plans with an embedded prescription drug benefit or MAPDs for short.

1) Covered Insulins

The Senior Savings model has been in effect for a few years with some PDPs and some MAPDs. It will now be across the board with companies sponsoring PDPs or MAPDs. This doesn’t mean that every plan is covered. It does mean that if, for example, Acme Health offers three PDPs, one of them must include the Senior Savings Model for covered insulins.

The Senior Savings Model limits your cost-share to $35 per month for covered insulins. Note: this doesn’t mean that every insulin is covered. It means that the insulins on the plan’s formulary are covered. Your cost-sharing for non-covered insulins will likely be higher.

More details are as follows:

  • You won’t pay more than $35 for a one-month supply of each insulin prescription covered by your plan, no matter what cost-sharing tier it’s on, even if your plan has a deductible that hasn’t been met.
  • While some of you already have plans that offer $35 insulins, this legislation ensures that all seniors who use insulin will benefit from this out-of-pocket cost limit.
  • Anyone on Medicare’s Extra Help program will continue to pay the CMS statutory maximum cost share for insulin, which is less than $35.
  • Some PDPs will offer covered insulins at less than the $35 copay.

Please check with us for more information.

2) Covered vaccinations

PDPs will cover most Part D vaccines for a $0 cost share, even if a plan has a deductible that hasn’t been met. As of this writing we don’t know what most is.

Why You Can Benefit from an Annual PDP Check up Every Year

Over the years we’ve heard many people say, “I’m happy with my plan and don’t want to change.” Question: Would you still be happy if the copay for one of your expensive meds doubled?

One very popular plan moved the pricy blood thinner Eliquis from a tier 3 to a tier 4 drug. Your copay would literally double if you stayed with that plan. Not good for your pocketbook! We have seen other changes that makes it worthwhile to do a PDP checkup.

Here’s another example. Most PDPs still have the generic Zetia (Ezetimibe) as a tier 3 drug, which is subject to the deductible. We discovered one plan that ranks Zetia as a tier 2 drug, meaning that it has a  low copay and is NOT subject to the deductible.

PDP Helper

Contact us or use our convenient PDP Helper link to send us a list of your current prescriptions.

Medicare Advantage News

We have seen an expansion of Medicare advantage plans (MA) into counties that previously have had either none or every limited MA options. Other counties have even more plans added to their list.

Noteworthy examples:

Idaho: Benewah County (St. Maries), has a large, national company starting service in 2023.

Montana: Several rural counties such as Granite, Powell, Deer Lodge, Beaverhead, Jefferson, and others have gone from one carrier to three carriers.

Wyoming: The MA offerings in Wyoming have previously been very limited. They have expanded for 2023. Please ask us for more details.

Two Idaho Medicare Supplements Changes

Starting in March 2022, Idaho is now using a community rate structure for Medicare supplement plans. This means that there is one rate for all ages. Many people 75 and better have already switched to plans with lower rates. This only applies to newly issued polices. This does not affect your current plan, unless you make a change.

The new Idaho birthday rule creates a 63-day open enrollment period to change your Medicare supplement, even if you have a medical condition that normally would disqualify your application.

Please check with us to determine your eligibility for lower rates.

Do I Need to Renew my plan for 2023 if I’m Not Making Any Changes?

You do not. Your existing plan auto renews for 2023. The exception would be if your plan is being discontinued for 2023. As of this writing, we don’t know of any.