2025 Part D Moop will be lower than 2000.00?

[Special Agent]

heard from a trusted source today that because of something in the Inflation Reduction Act the calculations for the 2000.00 moop will be based on the standard part D model which for 2025 is 590.00 deductible and 25% in initial stage and whether or not a part D plan has a deductible the consumer gets credit for 590.00 deductible and 25% after that.So lets say someone is on Ozempic at tier 3 and cost of drug is 1000.00 their real moop will be about 270.00 even though consumer is only paying tier 3 copay of say 45.00 they are getting a 250.00 credits each month ( 25% of 1000.00) towards their moop so after about 6 months( 250.00 x 6) or 45.00 copay x 6= 270.00 oop they have reached moop of 2000.00

Carriers will have to eat these additional cost whether or not a plan has a deductible so we may see part d deductible on mapd next year- or formulary reductions.

 

[hockeyday]

heard from a trusted source today that because of something in the Inflation Reduction Act the calculations for the 2000.00 moop will be based on the standard part D model which for 2025 is 590.00 deductible and 25% in initial stage and whether or not a part D plan has a deductible the consumer gets credit for 590.00 deductible and 25% after that.So lets say someone is on Ozempic at tier 3 and cost of drug is 1000.00 their real moop will be about 270.00 even though consumer is only paying tier 3 copay of say 45.00 they are getting a 250.00 credits each month ( 25% of 1000.00) towards their moop so after about 6 months( 250.00 x 6) or 45.00 copay x 6= 270.00 oop they have reached moop of 2000.00

Carriers will have to eat these additional cost whether or not a plan has a deductible so we may see part d deductible on mapd next year- or formulary reductions.

Asked and answered

 

[Special Agent]

Asked and answered

can you provide link to thread about this i don't see it here?

 

[kgmom219]

That's how it works now in the donut hole. Its why there's never an easy answer and pharmacy selection is critical.

2025 AEP is going to be super fun!

 

[yorkriver1]

I plan to start gathering drug lists in July.

 

[Chazm]

Except most, if not all plans will have a % for Tier 3 most likely.

 

[Yagents]

NAHU Washington Update - 04/26/2024

That said, how much of this AEP will be disruptive due to the rule and how much of it will be a consequence of the Inflation Reduction Act? We have believed for some time that capping the out of pocket expense and limiting premium increases would affect plan pricing, particularly for Part D carriers. Expectations are that premium increases will double and perhaps triple for some standard plans and that they may be non-commissionable as well. The additional $100 payment is considered an all or nothing payment and with already thin margins, advisors are likely to shift many of these clients to Medicare.gov for service. Adding to the problem is a new provision of the IRA to defer paying for pharmaceuticals at the drug counter for expenses exceeding $500. Little is known how this will work but we do know that beneficiaries can request deferment even in the 12th month of the plan year. We expect formularies to change substantially and beneficiary requests to increase so serving your current book of business will take time away from adding new clients. In this environment, the role of the FMO will be more critical than ever as you seek ways to structure your time efficiently. Many FMO have already anticipated this need and are putting into place ways to ease your workflow.

 

[Special Agent]

Except most, if not all plans will have a % for Tier 3 most likely.

That makes sense.IMO any stand alone part D plan with a robust formulary will have the 590.00 deductible and we will see deductibles for brand names return to many of the core MA plans for the biggies like UHC,Aetna ,Humana etc.

 

[DonP]

NAHU Washington Update - 04/26/2024

That said, how much of this AEP will be disruptive due to the rule and how much of it will be a consequence of the Inflation Reduction Act? We have believed for some time that capping the out of pocket expense and limiting premium increases would affect plan pricing, particularly for Part D carriers. Expectations are that premium increases will double and perhaps triple for some standard plans and that they may be non-commissionable as well. The additional $100 payment is considered an all or nothing payment and with already thin margins, advisors are likely to shift many of these clients to Medicare.gov for service. Adding to the problem is a new provision of the IRA to defer paying for pharmaceuticals at the drug counter for expenses exceeding $500. Little is known how this will work but we do know that beneficiaries can request deferment even in the 12th month of the plan year. We expect formularies to change substantially and beneficiary requests to increase so serving your current book of business will take time away from adding new clients. In this environment, the role of the FMO will be more critical than ever as you seek ways to structure your time efficiently. Many FMO have already anticipated this need and are putting into place ways to ease your workflow.

Kingdom mom laughed at me when I said part D premiums will double or triple .The 6% increase is bs . They’ll simply file for new plans with the pricing built in . As I said it’s going to be a tough ass aep for anyone with a good sized book . This is one time I’m glad I got a good sized dual/lis amount . There drug prices built in .

 

[DonP]

That makes sense.IMO any stand alone part D plan with a robust formulary will have the 590.00 deductible and we will see deductibles for brand names return to many of the core MA plans for the biggies like UHC,Aetna ,Humana etc.

So that means you’ll be scrambling to move a lot of clients . If you don’t your phone will be ringing non stop all of Jan as people have nasty suprises