How is the $2000 MOOP calculated?

[selfgen]

I went to an Aetna rollout and Humana rollout this week and neither could clarify this. I thought it was the member’s out of pocket otherwise, but neither carrier confirmed this. Aetna said that amount includes payment from other sources such as the plan, drug company discount.
What is correct?

 

[straightnochaser]

I went to an Aetna rollout and Humana rollout this week and neither could clarify this. I thought it was the member’s out of pocket otherwise, but neither carrier confirmed this. Aetna said that amount includes payment from other sources such as the plan, drug company discount.
What is correct?

I was under the impression the $2k was member responsibility hence everyone talking about $160 a month

 

[DonP]

Incorrect . There’s other reimbursements from the carriers and drug company rebates going toward the $2k. I’ve read 4 times the avg person will spend $1200 to get to the $2k moop. I don’t believe there’s an accuarate wa for an agent to fig this out

 

[Special Agent]

Incorrect . There’s other reimbursements from the carriers and drug company rebates going toward the $2k. I’ve read 4 times the avg person will spend $1200 to get to the $2k moop. I don’t believe there’s an accuarate wa for an agent to fig this out

just saw some demo's on this today.If the tier 3 is a fixed copayment like on UHC plans there is many scenarios where they will only pay about 600.00 to hit the max

 

[DonP]

just saw some demo's on this today.If the tier 3 is a fixed copayment like on UHC plans there is many scenarios where they will only pay about 600.00 to hit the max

You said the key words “ many scenarios “ . There’s no way to manually fig out .I’ve read were a fixed cost copay like $47 . If the % like 25% is let’s say $150 . You get the credit from the higher $150 vs your $47 or $103 toward you moop . I think it’s Critical to sell mapd’s and pdp’s with fixed tier 3-5 copays . I’m not going to go down rabbit holes to try to explain this . Im tell all “ if you have expensive drugs you’ll have to to a $495 deductible . But once you hit that most drugs will be about the same cost as before . But the good news is you can never pay more than $2k in a yr and a great % of people pay less than that . So all those expensive drugs you have you can never pay more than $2k total . If you go to the pharmacy and they want $400 let’s say for a drug . You can call the company and set a payment plan up .

 

[agentinCali1987]

Who really Fn cares we aren’t getting paid now , it’s Medicares problem

 

[hockeyday]

Who really Fn cares we aren’t getting paid now , it’s Medicares problem

Who's not getting paid, dude this is a bigger deal on mapd than pdp, and if your thinking your Wellcare members will stick with them hold on the anoc just hit and I got 3 calls today from pissed off people, guess what meds not covered on the slimmed down formulary let the fun begin

 

[straightnochaser]

Who really Fn cares we aren’t getting paid now , it’s Medicares problem

You don’t sell MAPD?

 

[agentinCali1987]

I do but most MAPD plans are more comprehensive than stand PDPs never really have to worry about drug costs too much , this could change next year though . A majority of drug issues come from stand alone , not wasting my breath on them this year