Medicare Supplements and Part D Prescription Drug Plans

Do Medicare Supplement plans include or cover Part D prescription drug plans? I wish the answer was yes.   Up until 2006   Medicare Supplement plans H, I and J existed and they did cover medicines on those plans.  Here is what they would do as I remember.  There was a $250 deductible and it would cover your medicines.  You would pay 50% and the plan would cover 50% up to a set amount by the insurance company.    Those Medicare supplement plans would be pricey, especially the Plan J.  When I was talking with people almost everyone back then would ask me if their medicine was covered in their plan.  If you didn’t have those particular plans then the answer was no.  Most people wanted their medicine covered by EVERY plan but it just did not exist.   Most people would still buy a Plan F or Plan and back in 2001  I was on the forefront selling Plan G’s if it was cheaper and made since over Plan F. Some people would ask me the question, do I need a Medicare Supplement plan g ?  Now for a few years, other agents have finally figured that out.  Plan G is cheaper and still covers their needs.  If you still have one of the H, I, or J plans.  I could just imagine what the prices are now. Sky High.  If you do have one of those plans and want out.  Please call me:  Mitch Winstead at Allstar SeniorBenefits  Toll-free 866-598-8170  So after all of that frustration when talking with people and them wanting Prescription drug coverage.  Low and behold  President George w. Bush delivered.    Awesome!!  our troubles are over!  We got coverage!   Hold the phone though.  Boy did they make this system complicated.  And it’s not a panacea either.  Just like most things, the government sticks their hands in  Its, not the best coverage and there are several catches to it.  First what is still being talked about today is that If a Medicare-eligible person does not enroll at age 65 then there is a 1% per MONTH penalty for each month people DON’T sign up.   That means if an eligible person does not enroll in 24 months  That person will have to pay a 24% penalty!!  Not good!

Also, people cannot make a change in their current plans until October 15th of each year and then that plan does not go into effect until January 1st of the coming year!   Also, all medicines may not be covered.  There is a maximum amount covered.  There are co-pays, tier groups, and A DONUT HOLE!   Wow.  ok,  so we got coverage now.  But this really what we wanted?  Probably not.  Agents who try to sell these Part D plans have a difficult time selling it because it’s so hard to explain.   The companies that agents contract with a now stipulating that there must be training and certifications involved to sell to a client.   It is maddening.  I am in a situation now as an Independent broker that will help people with this.  But my it is confusing.   There have been a number of complaints from prospective clients on understanding these plans.

Let me go into more detail on how the Part D plan works.  Part D plan prices are based on plan type and NOT by age.    Here is an example:  $30.00 monthly premium  NO deductible. (at this time of writing the article, most plans have a deductible) but a couple does not.  With a premium of $30.00, you would get an account just like everyone else of $4950 annually.  So your medications would be broken down into tier groups such as tier 1-4.  The higher the tier, the higher the co-pay.  Tier 1 is usually generics with either a 0-$10 co-pay. Tier 2 is a higher priced generic med or lower-priced brand drug such as a statin medication for cholesterol with a co-pay of $20.00.  The co-pay  Tier 3 drugs start getting more expensive with a co-pay of $30-40.00  Then the tier 4 meds go on a $50-60 on up for a co-pay or based on a percentage of the drug cost -for example, 35%.   Now most importantly, you would want all or most of your medications you take to be covered by the plan you purchase.  I have to forewarn you some of your medicines may not be covered in a particular plan.  So let’s say you have paid the $30 monthly for a plan and you go to the pharmacy and you pick up a tier 1 drug which is $0-10.00 as a co-pay and it works well for you.   That’s great!    It’s not that simple all of the time.  So you paid your co-pay and remember the $4950 as your account.   The co-pay of $10 and the cost of the medicine itself is, for example, $20.00  The total cost of the med will start to be deducted out of your account   Lets do some simple math.   So you start with $4950 minus $10= $3840 right.  The problem is when you have multiple medications at different tiers and co-pays.   The annual account of $3850 starts going down over several months especially if you have tier3 and 4 medications.  Then people start getting into the dreaded DONUT hole.   So let’s take a look at another scenario   YOu go to the pharmacy and have a co-pay for a tier 3 medicine.  You pay out $50 then have 2 tier 2 medicines with a co-pay of $25.00 and 3 tier one generic medicine with a co-pay of $10.00  So that’s a pharmacy trip of $130 for each month.   It starts adding up quickly.   Some of my clients are on some Tier 4 drugs that have expensive co-pays with prices of $140.00 for that medicine.   So if the medicine costs $500, that $500 starts being deducted from your annual $4950.  Fortunately, most people are able to stay out of the donut hole but it can get scary for people when they get close to it.   If you do go into the donut hole,  your plan may offer a discount on the medicine to you.  Let’s talk about the possible deductible.  So you get a plan for $30.00 monthly and the deductible is $400 before the plan starts paying anything on your medications.  So let’s look at this further  $30.00 a month and a $400 deductible   Lets do the math by taking $400 divided by 12 months = $33.33.  So now before the plan pays anything, you are looking at $30.00 premium + $33.33 now equals  $63.33 each month in this example breakdown of 12 months.  Plus a co-pay for a tier 2 medicine and 2 tier 1 medicines and one tier 3 medicine   So doing the math again  $63.33 plus 2 tier one medicines  = $20.00, 2 tier 2 medicines = $50.00 and one tier 3 medicines at $50 now equals $120 monthly and the $73.33 premium/deductible.  equals almost $200.00 a month.   In my opinion, it is best not to have a deductible involved.  However, there are only a small number of plans that do not have a deductible. Let’s talk a little about why a person may not take out a plan when first eligible.   Remember there is a 1% penalty for each month a person does not take out a plan.  Some people like my Mom just think, it’s another monthly expense and don’t want to pay another bill.   Some people don’t want to be “bullied” by the government that tells them you HAVE to take out this plan or you are going to get penalized.   Furthermore, some people are just not taking ANY medicines or just 1 or 2 and feel that I just do not need a plan right now.   Others are going to take the risk that they are not going to need this type of plan because they are healthy.     I have had clients when the Part D plans first came out go and sign up for the cheapest plan available because they did not want to pay a penalty.    My thought is 30-50% of people out there are going to need to enroll.  If not then at least enroll 2 years from the point you are eligible.  You have to ask yourself this question.   Is my health going to get worse or better as you get older?  I think we all know the answer to that.   It is going to worsen.   I want to make one thing clear, I won’t twist your arm one way or another to enroll in a Part D plan.   I think the plans need fixing.   The deductibles are too high.  They are confusing.   Some medicines are not covered.  There are co-pays.   The plan does not pay enough or cover enough medicines.   On top of that there is red tape.   Such as:  even if your medicines are covered, you have to try alternate cheaper medicines sometimes before you get the medicine actually ordered for you by the Doctor.   I will give you an example  Lets say that you have high blood pressure.   So we know already there are a lot of blood pressure medicines available.  But your Doctor wants you to have one of the newest medicines available instead of using   an older med that has been around for awhile.  SO this new med IS covered by your plan but the plan wants you to try an older med due to the cost of a newer med.  Sometimes its called something like “step up”   If the old med doesn’t work, after a while then the company will approve the new one.additional paperwork in order to get a certain medication approved on your behalf.  Also, they have the Doctor fill out  I am not sure about you.  I don’t like insurance companies “playing” around with my health.  It is frustrating that the companies that provide these plans are not making this easier to use.   Also, let’s say you have a plan and you go into the donut hole.   Now your medications are not paid for by your plan,   You have to pay out of pocket for the cost of the medicines involved.    Some discount cards are able to help save you money but the plan you have may not allow you to use the discount card.   Its crazy, I know.  I am not endorsing one way or another to encourage you or discourage you from buying a plan.   It is up to you.  The point of this article was to provide answers for you and hopefully give you insight on how these plans work.  Also that Medicare Supplement plans no longer have coverage for medications.   Until our government steps in and fixes this problem as far as bringing prices down on premiums, we are stuck with this model.   I can help you as much as I can by doing a search based on your medications you take. I do this free of charge to you if you are one of my customers.   By doing this for you it will save you hours of time and frustration knowing which plan is best for you and if your medicines are covered with your plan.  It will also let you know your premiums and deductible and will be able to get a general idea of your co-pays also.  These plans as mentioned before are confusing especially if this is your first time enrolling in a plan.  Also, some Medicare Advantage plans may cover some medicines BUT please do not enroll in ANY Medicare Advantage policy before contacting me first.  As I have written in another article on this website.  Medicare Advantage policies have numerous problems that can cause issues.  My advice is to stay away from Medicare Advantage.  I can also provide you help in finding a good valuable drug discount card if you don’t want to enroll in a Part D Medicare prescription drug plan.  Any questions can be asked about Medicare Supplements, Life insurance, final expense insurance, Long Term Care etc.  I am here to help you.  My agency has tons of experience in Medicare.  We have over 34 years of experience in the insurance business.  We are sure we can help you too.  Give us a try.   We have several customer reviews/testimonials on our website at  https://www.allstarseniorbenefits.com     Or at my toll-free number 866-598-8170  or 910-538-4547 or  Facebook http://www.facebook.com/medsuppguru