Maintenance meds. to BCBS, ....Can I change to BCBS from MEDICARE?

[annon123]

I think this is what you have? This is for federal employees and talks about how it works after you/your spouse retires. It is hard to help you if we don't know what you have. Besure to click on each of the tabs.

Combining FEP and Medicare

www.fepblue.org

Is this your drug plan? Looks like that is part of BCBS with no extra premium. If your one drug is not on their formulary then you may need a "regular" drug plan (can't change though until near the end of the year and it would go into effect 1/1/26 unless you fall under one of the exceptions (for example just turned 65 or are on the advantage plan they offer for government employees instead of using it as a supplement). Regardless of what you have all drug plans across all programs have a $2000 max out of pocket which includes the deductible.

FEP Medicare Prescription Drug Program (MPDP)

Learn more about our Medicare prescription drug program for eligible members.

www.fepblue.org

 

[LostDollar]

Is this your drug plan? Looks like that is part of BCBS with no extra premium. If your one drug is not on their formulary then you may need a "regular" drug plan (can't change though until near the end of the year and it would go into effect 1/1/26 unless you fall under one of the exceptions (for example just turned 65 or are on the advantage plan they offer for government employees instead of using it as a supplement). Regardless of what you have all drug plans across all programs have a $2000 max out of pocket which includes the deductible.

I am not sure it is prudent to be starting a discussion about drug plans with a (possible) need for change if one drug is not covered.

The thrust of all the advice I see here from agents during PDP season is that one should look at the "Whole Picture".

Starting with: we don't even know what the cost of the Medication in question is.

(We won't name names, but speaking as an elderly Medicare Beneficiary from KS, I can say some of us are capable of complaining loudly when our $20 medication is not covered by insurance. Some of us may even be attitudinally capable of paying $40 a month for a PDP to be sure our $20 a month medicine is covered by insurance. )

(And a secondary piece of advice I see offered by agents is that one is often ill advised to mess with a prospect's government health coverage at all. )

One VERY important consideration in relation to the coverage you provided links to is this :

Don't lose your coverage

As long as you don't cancel your health insurance, it will never go away for as long as you're retired. If you do choose to cancel your insurance, you will never be able to re-enroll in a health insurance plan through the Federal Employees Health Benefits (FEHB) Program. If you want to try a different plan such as Medicare Advantage or Tricare, you may suspend your coverage and still retain the right to re-enroll in the FEHB Program. To learn more, visit opm.gov/retire.

Again, she needs to look at the whole picture with a knowledgeable agent who understands both the government and Medicare insurance products rather than making a knee jerk change to what may be very good health coverage overall, based on one medicine. We are talking about possible non-revocable changes which could affect her health coverage for the rest of her life.

Using a drug discount card, and asking her doctor about the possibility of a different medication which will accomplish the needed task, are both options which I have not seen raised.

I understand, from reading posts here, that there are illnesses which require 1 specific (often quite expensive) medication to treat. However I don't think that is true of all chronic conditions. Based on a combination of my reading here and my personal experience at my doctor's office with a series of PCP's caused by staff turnover, I see that some chronic conditions can be treated acceptably with one of several medications.

Discussions here also indicate that GoodRX or similar drug discount card can be used cost effectively along with PDP coverage as long as the patient understands they don't have Medicare/PDP coverage on the drugs purchased with the discount card.

 

[annon123]

I am not sure it is prudent to be starting a discussion about drug plans with a (possible) need for change if one drug is not covered.

The thrust of all the advice I see here from agents during PDP season is that one should look at the "Whole Picture".

Starting with: we don't even know what the cost of the Medication in question is.

(We won't name names, but speaking as an elderly Medicare Beneficiary from KS, I can say some of us are capable of complaining loudly when our $20 medication is not covered by insurance. Some of us may even be attitudinally capable of paying $40 a month for a PDP to be sure our $20 a month medicine is covered by insurance. )

(And a secondary piece of advice I see offered by agents is that one is often ill advised to mess with a prospect's government health coverage at all. )

One VERY important consideration in relation to the coverage you provided links to is this :



Again, she needs to look at the whole picture with a knowledgeable agent who understands both the government and Medicare insurance products rather than making a knee jerk change to what may be very good health coverage overall, based on one medicine. We are talking about possible non-revocable changes which could affect her health coverage for the rest of her life.

Using a drug discount card, and asking her doctor about the possibility of a different medication which will accomplish the needed task, are both options which I have not seen raised.

I understand, from reading posts here, that there are illnesses which require 1 specific (often quite expensive) medication to treat. However I don't think that is true of all chronic conditions. Based on a combination of my reading here and my personal experience at my doctor's office with a series of PCP's caused by staff turnover, I see that some chronic conditions can be treated acceptably with one of several medications.

Discussions here also indicate that GoodRX or similar drug discount card can be used cost effectively along with PDP coverage as long as the patient understands they don't have Medicare/PDP coverage on the drugs purchased with the discount card.

There are expensive drugs out there - as in the hundreds of dollars of copay. And there are some that aren't on some formularies that cost a fortune. The prudent check their coverage of the drugs they are already on each year to see what D covers and what their overall costs plus premium will be each year. Until this person posts more information so people even know what the situation is and whether or not she has D or federal D or advantage plan D no one can give any useful advice about what to do. I think most agents do the obvious - figure what is the total cost is so telling people drug cost isn't the total picture is common knowledge amongst agents although some individuals doing this on their own may or may not take that into consideration. And I'd suspect agents check each year for the people who use them to see if switching will save money on D (or for that matter on a MAPD although that has more considerations in total cost besides drugs).

Goodrx and similar sometimes saves money and sometimes doesn't. The different coupons save different amounts of money at different pharas and between the different companies. Money can also sometimes be saved through the Mark Cuban drug company that also doesn't accept insurance. This is very individualistic to the person and no blanket statements can be made.

The client I helped the other week would have saved money for one expensive drug (all the alternative drugs were equally as expensive) on a $98/month premium plan and would have paid additional for the drug. Then her doctor got her in a program to pay for that drug for a year. So we went with Wellcare as now the meds she had left were cheaper on the no premium version of that D so the total cost was cheaper. And yes I made no money using Wellcare for her but that saved her the most money.

Again until the person asking the question answers some of ours it is incredibly hard to know how to help her.

 

[LostDollar]

There are expensive drugs out there - as in the hundreds of dollars of copay. And there are some that aren't on some formularies that cost a fortune. The prudent check their coverage of the drugs they are already on each year to see what D covers and what their overall costs plus premium will be each year. Until this person posts more information so people even know what the situation is and whether or not she has D or federal D or advantage plan D no one can give any useful advice about what to do. I think most agents do the obvious - figure what is the total cost is so telling people drug cost isn't the total picture is common knowledge amongst agents although some individuals doing this on their own may or may not take that into consideration. And I'd suspect agents check each year for the people who use them to see if switching will save money on D (or for that matter on a MAPD although that has more considerations in total cost besides drugs).

Goodrx and similar sometimes saves money and sometimes doesn't. The different coupons save different amounts of money at different pharas and between the different companies. Money can also sometimes be saved through the Mark Cuban drug company that also doesn't accept insurance. This is very individualistic to the person and no blanket statements can be made.

The client I helped the other week would have saved money for one expensive drug (all the alternative drugs were equally as expensive) on a $98/month premium plan and would have paid additional for the drug. Then her doctor got her in a program to pay for that drug for a year. So we went with Wellcare as now the meds she had left were cheaper on the no premium version of that D so the total cost was cheaper. And yes I made no money using Wellcare for her but that saved her the most money.

Again until the person asking the question answers some of ours it is incredibly hard to know how to help her.

I agree more information is needed.

My point was that you started a discussion about her drug coverage by saying she might need to switch away from a government plan to another plan to get coverage for one drug without mentioning there are other options COMMONLY DISCUSSED ON A REGULAR BASIS BY AGENTS IN THIS SUBFORUM.

Your comment about the possible need for replacement also did not highlight for OP the fact that certain change decisions on her part might cause her to irrevocably loose her government coverage.

I consider that highly inappropriate as it has the potential to create a tunnel vision decision making process in the mind of a Medicare Beneficiary who feels urgency to act but who does not fully understand their options.

 

[somarco]

And I'd suspect agents check each year for the people who use them

You might be surprised at the number of folks, clients, policyholders and agents, who don't bother to run Rx reports.

Some of my clients don't read the ANOC (even though I remind and admonish them) when it comes to them in the mail. Some (several?) never bother to look for formulary or preferred pharmacy changes.

 

[somarco]

I am not sure it is prudent to be starting a discussion about drug plans with a (possible) need for change if one drug is not covered.

Med's often change mid-year including the addition of very expensive meds.

Even though you may not be able to change until AEP a good agent will offer to help determine if the new med is on the formulary and how much it will cost under the existing plan.

A good agent will also offer advice about ways to lower their cost if they need to fill the Rx outside the plan. Canadian/worldwide resources can be a good starting point along with PAP subsidies and grants.

As you know, GoodRx, SingleCare, etc only work with generics.

 

[Medicare bro]

Did we establish if she is still on Fed BC/BS? I have never seen it where it would be wise to switch from that to Original Medcare.

 

[annon123]

I agree more information is needed.

My point was that you started a discussion about her drug coverage by saying she might need to switch away from a government plan to another plan to get coverage for one drug without mentioning there are other options COMMONLY DISCUSSED ON A REGULAR BASIS BY AGENTS IN THIS SUBFORUM.

Your comment about the possible need for replacement also did not highlight for OP the fact that certain change decisions on her part might cause her to irrevocably loose her government coverage.

I consider that highly inappropriate as it has the potential to create a tunnel vision decision making process in the mind of a Medicare Beneficiary who feels urgency to act but who does not fully understand their options.

Only a bad agent would not look at the details of someone's plan before suggesting any changes - if any changes are even appropriate for someone's needs. As you are not an agent suggesting that it is highly inappropriate to even mention the range of what someone might end up doing - especially when you agree that more information is needed to even know where to begin with respect to how to advise someone, without knowing what goes in a meeting between the agent and the client - is making a boat load of assumptions. All of them negative about the agent since you are being critical in how you worded that and the tone of how you worded that. You have no way of knowing what will actually go on if this person becomes someone's client. It is not inappropriate to mention there are potentially choices available, despite you thinking it is.

She has an uncovered expensive drug. She wants to somehow get it covered. Therefore we talk about D. She hasn't been clear enough about her exact plan she has now with, I presume federal because her husband was a federal employee, BCBS for any of us to give her good advice - as has already been stated by several posters. Depending on what plan she has and the details of that plan then different range of choices mentioned on this thread may be appropriate. If her only D is the federal BCBS then she has different options than if she has an MAP or MAPD with her BCBS. That, however, won't be known until we know more and know what her options are when she has federal BCBS.

As the federal BCBS has a separate D, separate from the supplement version of BCBS which sounds, from reading, very much like it may work like F, which, from her post it sounds like she may have (unless she has the MAPD version of medicare) then it is too late to change her D unless she is in her initial sign new to medicare up period. Of course her options are different if she has a MAPD or a MAP and/or decides to switch to a MAPD. We just don't know yet. But letting people know there may be options is, in my opinion, is not highly inappropriate.

 

[annon123]

You might be surprised at the number of folks, clients, policyholders and agents, who don't bother to run Rx reports.

Some of my clients don't read the ANOC (even though I remind and admonish them) when it comes to them in the mail. Some (several?) never bother to look for formulary or preferred pharmacy changes.

I guess because I do and presumed people were conscientious and did so I made a wrong assumption. Oops. Of course I don't have a zillion clients yet so the time sink that would take for a zillion clients is not an issue I yet have. Who knows what I'd do faced with that reality. I'd hope I'd still do that but then if it meant 100 hour weeks I might approach it differently.

 

[somarco]

I don't have a zillion clients yet so the time sink that would take for a zillion clients is not an issue I yet have

I don't have a zillion clients . . . ask Don if you don't believe me.

But I do read the forums and other sources to know there are a lot of slacker agents who put in minimal effort to service clients . . . and a number complain about having to do anything, especially running an Rx report.

For the first 18 years or so of my career I was on the wholesale side of health insurance and brokers were my clients. If I had to put a figure on it, probably 80% were slackers who knew how to SELL the product but were practically clueless about how it worked.

I don't think things have changed that much in the last 20+ years.