Paula became eligible for Medicare due to a disability and was enrolled on the 25th month after her benefit checks started with the help of the social security office. Candidates under the age of 65 in the state of Ohio can enroll in an independent drug plan or a Medicare Advantage Plan which limits their healthcare expenditures and offers prescription drug coverage. Medicare supplement insurance is not available to recipients who are under the age of 65 in the state of Ohio.
Enrolling in an independent prescription drug plan exposes them to the liability of affording 20% of all medical costs with no maximum payment. Social security only offers the drug coverage as the Medicare Advantage plans are offered by independent insurance companies. They will help the client initially but it is the beneficiary’s responsibility to shop it each year as the plan and their own needs change.
While the prescription plan was appropriate for Paula in 2017, she would have been better served by a different plan in 2018 due to a formulary change. One of her medications moved from a Tier 2 level to Tier 3 increasing her expenditure under the current plan by over $1000 in the new year.
Prescription drug plans have symbiotic relationships between the drug manufacturer, the drug plan and participating pharmacies. The better the relationship between these entities offers the best cost share for the client. The other variable within the plan is the premium of the plan. The higher premiumed plan will have better cost sharing with the more expensive brand prescriptions even though they may initially appear more.
Paula’s premium for 2018 is only a little over $18 a month but her copays at the pharmacy are $300. Under the $56 monthly premium plan her copy’s would only be $45 for the same prescription. Carla was going to continue her drug plan from 2017 as she could afford her inhalers under that plan. She was quite surprised to discover that same inhaler was not on the formulary in 2018 but fortunately she was in the annual enrollment period and able to make a change.
Annual enrollment is October 15 through December 7 this year and anyone enrolled in either an independent prescription drug plan or Medicare Advantage plan should shop their current prescriptions to ascertain the costs for the following year. The current plans are only contracted for 12 months and do change. Preferred pharmacies can also change which will drive your cost up as well. Don’t be caught unaware as Paula and have to pay more for your drugs.
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