- 2,507
Ex: if an MAPD has $440 deductible for T3-5, would the $150 ($590 (-) $440) apply toward the $2,000 since the plan is “giving” this to the mb? It is not a big credit, but it’s something.
Does a Partial Part D deductible count toward the $2,000 limit?
- Thread starter wehotex
- Start date
I believe the full $590 goes towards the $2000 max oop. When I run the BCBS MAPD that has $0.00 premium, $0.00 deductible, and $47.00 Tier 3 for eliquis it shows the client paying $47.00 for 11 months and then their $2000.00 is met. 25% of eliquis is $145.75 so take that x 11 and it's only $1595.00 so that tells me they are counting the full $590 deductible bc $2000.00 is met in November. Total cost for client would be $517.00 for the year for a drug that costs around $600/month.
I mentioned to a BCBS rep at a meeting that they are gonna lose their ass since they are only company with this format, he shrugged his shoulders and said we get paid for it.
Ozempic is even crazier, client would pay $47.00 for 7 months and hit their $2000.00 max oop. $12000/year drug and client will pay $329.00.
I mentioned to a BCBS rep at a meeting that they are gonna lose their ass since they are only company with this format, he shrugged his shoulders and said we get paid for it.
Ozempic is even crazier, client would pay $47.00 for 7 months and hit their $2000.00 max oop. $12000/year drug and client will pay $329.00.
Look for all MAPD’s to have premiums going forward. Zero dollar premiums will be a thing of the past.
Don't think premiums will change but all will have a Part D deductible for sure in 2026.
MedicareWAA
Guru
- 409
Yes, it does.
< $590 deductible is very valuable, but not as valuable as plans with a fixed copay on brand drugs after the deductible.
I’ve run about 75 drug plan quotes . The copays vs %is massive on tier 3-5. I noticed Aetna has $590 deductible and % copays pretty much nationwide . Example is ozempic tier 3. With copays and $450 deductible it seems most people spend $850-$900 and there $2k troop is met .That said i expect carriers to see the landscape and change to %’s in 2026
Jim Wright
Super Genius
- 215
Yes, all plans with enhanced benefits are calculated as if they were the standard benefit as it pertains to the Troop
MedicareWAA
Guru
- 409
The plans knew how the economics worked. They chose to spend more of their rebate dollars on a better Part D benefit. Perhaps there will be issues with risk pools but Part D has mechanisms to protect plans when utilization is out of control. Plus the MA revenue is risk adjusted, and plan switchers already come well coded from a competitor.
We might see everyone move to coinsurance in 2026 but it wouldn’t be due to carriers not understanding how the math worked this year.
MedicareWAA
Guru
- 409
Why do you lose? Your drugs are still dirt cheap, and there are still dirt cheap drug plans out there.
