Several other issues exist when switching carriers . Going from a non deductible or lower deductible plan to a deductible rx plan . Any difference in tier levels on drugs . More so on future tier 3 and above drugs . Just had a client flipped from a no rx deductible tier 3 and flat copays to a company with $590 rx deductible and 25% tier 3 copay . They wanted $800 on her tier 3 drug 1 week ago first fill . I moved her back to old plan for 5-1
2K out of Pocket Drugs question
- Thread starter vic120
- Start date
Moving from a $0 deductible plan to a drug plan with a standard deductible.
If your Medicare Part D plan had a $0 initial deductible and you use a Special Enrollment Period to change plans to another Medicare drug plan that has a $590 deductible, you may now be in the deductible phase of your new plan (you can read more about how your deductible is affected by previous drug purchases below).
How does this work? If you use a Special Enrollment Period to move from a Medicare Part D plan with a $0 deductible to a drug plan with an initial deductible, both what you have paid for your drugs and what your plan has paid for your drugs should count toward your new plan's initial deductible (but only your actual TrOOP from your first drug plan will transfer to your TrOOP in your new second plan).
If your Medicare Part D plan had a $0 initial deductible and you use a Special Enrollment Period to change plans to another Medicare drug plan that has a $590 deductible, you may now be in the deductible phase of your new plan (you can read more about how your deductible is affected by previous drug purchases below).
How does this work? If you use a Special Enrollment Period to move from a Medicare Part D plan with a $0 deductible to a drug plan with an initial deductible, both what you have paid for your drugs and what your plan has paid for your drugs should count toward your new plan's initial deductible (but only your actual TrOOP from your first drug plan will transfer to your TrOOP in your new second plan).
If I change my Medicare prescription drug plan during the year, will my drug deductible transfer to the new Part D plan?
Yes. If you use a Special Enrollment Period (SEP) to change Medicare drug plans during the year, you will find that both the total retail value of your drug purchases and the total value of your out-of-pocket spending (TrOOP) transfer to your new Part D plan.
q1medicare.com
- 1,081
Moving from a $0 deductible plan to a drug plan with a standard deductible.
If your Medicare Part D plan had a $0 initial deductible and you use a Special Enrollment Period to change plans to another Medicare drug plan that has a $590 deductible, you may now be in the deductible phase of your new plan (you can read more about how your deductible is affected by previous drug purchases below).
How does this work? If you use a Special Enrollment Period to move from a Medicare Part D plan with a $0 deductible to a drug plan with an initial deductible, both what you have paid for your drugs and what your plan has paid for your drugs should count toward your new plan's initial deductible (but only your actual TrOOP from your first drug plan will transfer to your TrOOP in your new second plan).
If I change my Medicare prescription drug plan during the year, will my drug deductible transfer to the new Part D plan?
Yes. If you use a Special Enrollment Period (SEP) to change Medicare drug plans during the year, you will find that both the total retail value of your drug purchases and the total value of your out-of-pocket spending (TrOOP) transfer to your new Part D plan.q1medicare.com
That what i thought i just haven't seen it in action yet to be able to confirm it and be able to tell prospects this is what should happen. As of now i just prepare them for the worst.
I have not seen it first hand either, but so many things about insurance (including Medicare) are gray, not black and white.
When I run into a situation that is a maybe, my approach is to let them know I will need to get back to them. Most of the time it is within one business day, in writing and shephardized.
I have no desire to tell someone "this is what will happen if you do (or don't do) this". And I would never try to convince them to switch, just so I could make/save a commission.
Lay out the facts as I know it, let them follow the links or ask a carrier for advice and interpretation.
I have E&O but so far have not had to test it and don't plan on starting. Losing a few hundred in commission's is a lot less costly than pressing for the sale and getting a nasty letter from the plaintiffs attorney.
YMMV
A MB was on a no deductible plan taking expensive drugs . She was switched to $590 rx plan . The pharmacy wanted $740 on the deductible plan . So in the real world that didn't work as the costs used weren't transferred
MedicareWAA
Guru
- 539
All "greater of" accumulated OOP costs transfer to the new plan.
Here's it's supposed to work, according to CMS and as reiterated by a few carriers, including United, in recent agent training:
1. Client has a $0 deductible drug plan
2. Client fills a hypothetical $600 medicine with a $10 copay
3. Client only pays $10 but $600 accumulates to the drug MOOP - $590 standard deductible + $10 copay = $600
4. Client then switches to plan with $590 deductible.
5. Client is NOT subject to the deductible because it already accumulated under their prior plan … even though the client only paid $10.
If a client experiences something different, it is a glitch and they should appeal it. They will win.
No idea whether Trump will keep it this way. Several experts have noted the law doesn't actually *require* it to be done this way - my reading of the text seems to line up with those experts. This is just how the government chose to implement the law.
Here's it's supposed to work, according to CMS and as reiterated by a few carriers, including United, in recent agent training:
1. Client has a $0 deductible drug plan
2. Client fills a hypothetical $600 medicine with a $10 copay
3. Client only pays $10 but $600 accumulates to the drug MOOP - $590 standard deductible + $10 copay = $600
4. Client then switches to plan with $590 deductible.
5. Client is NOT subject to the deductible because it already accumulated under their prior plan … even though the client only paid $10.
If a client experiences something different, it is a glitch and they should appeal it. They will win.
No idea whether Trump will keep it this way. Several experts have noted the law doesn't actually *require* it to be done this way - my reading of the text seems to line up with those experts. This is just how the government chose to implement the law.
Similar threads
