IRMAA & PDP

[Bill_Kiray]

This is a great subject for discussion. We decided to shoot a video on it with our take...

 

[ehall2]

I have an advantage plan with Aetna. My doctor prescribed a $2,000 prescription. Aetna won't pay any of this prescription. So, if your client is prescribed a $10,000 or $20,000 prescription it still may not be covered under part D.

 

[steveadlman]

I have an advantage plan with Aetna. My doctor prescribed a $2,000 prescription. Aetna won't pay any of this prescription. So, if your client is prescribed a $10,000 or $20,000 prescription it still may not be covered under part D.

Call the pharmaceutical company that makes the drug to see if you can qualify for financial assistance.

 

[LostDollar]

I have an advantage plan with Aetna. My doctor prescribed a $2,000 prescription. Aetna won't pay any of this prescription. So, if your client is prescribed a $10,000 or $20,000 prescription it still may not be covered under part D.

caveat, not an agent.
but you described an MAPD situation. Do you know that it specifically applies to PDP as well?

 

[LostDollar]

Caveat, not an agent.

IRMAA is not a penalty. I know it is probably difficult to convince Medicare Beneficiaries of that, but I think conversations among agents should not be referring to it as a penalty.

 

[Todd King]

Caveat, not an agent.

IRMAA is not a penalty. I know it is probably difficult to convince Medicare Beneficiaries of that, but I think conversations among agents should not be referring to it as a penalty.

Then what should it be called?

 

[Family Man]

I get similar comments from high earners. I have an honest conversation as always and tell them that, as an insurance agent, I cannot tell them to ignore a PDP just because the numbers don't make sense today. Some stick with their idea, most end up buying. As far as my own office policy when relevant, I always write "declined offered 'XYZ' policy" in my notes when it occurs...Some times on the PDP app signature page itself.

 

[Dave G]

The average Joe should never decline Part D coverage. Not even sure the high income guy should either. Don't you love it when somebody pulling down big bucks complains about what they pay for Medicare? We all know anything you see advertised on TV is expensive. Trying buying a couple of those every month without Part D and see how you like being "self-insured."

Just ran a drug review for someone who takes a Part D injection drug....retails at $18,199 a pop. With Part D she'd still pay $4,549 (25% co-pay) per fill. "Fortunately" she only needs it once every 3 months. Even better, she's not subject to IRMAA and qualifies for Patient Assistance from the drug manufacturer. Go to www.rxassist.org to search drugs that have these. It's not welfare....you'd be surprised at the income levels qualifying for reduced or even no-cost drugs.

 

[LostDollar]

Then what should it be called?[/QUOTE

(caveat not an agent)

What it actually is:

income-related monthly adjustment amount (IRMAA)

SSA - POMS: HI 01101.031 - How IRMAA is Calculated and How IRMAA Affects the Total Medicare Premium - 12/21/2021

Insurance products Medicare Part B and Part D have variable premiums based on Medicare Beneficiary's income.

The insurance products Medicare Part B and Part D also have late enrollment penalties when the Medicare Beneficiary does not enroll in a timely manner as defined by Social Security and Medicare.

 

[Dave G]

LostDollar said: Caveat, not an agent. IRMAA is not a penalty. I know it is probably difficult to convince Medicare Beneficiaries of that, but I think conversations among agents should not be referring to it as a penalty.

Todd King said: Then what should it be called?

Answer: It's a prosperity tax.