Medigap vs MAPD dilemna

[Hopes]

Scenario:

73 yo male on UHC Plan F paying $213/mo

Lost his PDP with UHC $90/mo. for non-payment (long story-account mix up). Unable to reinstate because he missed the grace period etc. He called carrier, begged forgiveness, offered to bring account current but they still said, "No."

He has no SEP to get another PDP so he's out of luck until 1/1.

He hit the donut hole around May and he's facing between $4k-4300 oop for remainder of this year on drugs. I did check GoodRx on a couple of the higher priced medications and it didn't save much.

He is diabetic.

As I see it, he is looking at the following through December:
$852 Plan F
$4-4300 drugs

Or, a CCP MAPD with $1600 oop for plan/meds in the same time frame.
Yes, there is a MOOP of $6700.

I do realize there is a potential to hit that MOOP. I do realize what this man would be giving up on his F. I, also, realize that he could GI back into a medigap at the beginning of the year.

I've thought about sliding him to a G plan which would save him about $50/mo but that's only a $200 savings.

The whole thing scares me for the obvious reasons and I would really appreciate some advice.

 

[Chazm]

That’s just one of those things that he has to decide on his own.

I would sit down with him and say look, you have the plan with the lowest copays/ded. As you know sir, pretty much zero.
I can change you to this diabetic plan where you may lose your doctor and incur higher cost for specialist and hospitalization. It’s a risky move and I wouldn’t blame you for staying put. But this plan does have drug coverage. It’s rolling the dice and I can’t tell you which will be better for you.

Now, this is all assuming like you say that he is GI starting in jan for a med supp

 

[Hopes]

That’s just one of those things that he has to decide on his own.

I would sit down with him and say look, you have the plan with the lowest copays/ded. As you know sir, pretty much zero.
I can change you to this diabetic plan where you may lose your doctor and incur higher cost for specialist and hospitalization. It’s a risky move and I wouldn’t blame you for staying put. But this plan does have drug coverage. It’s rolling the dice and I can’t tell you which will be better for you.

Now, this is all assuming like you say that he is GI starting in jan for a med supp

It's still so scary. I haven't checked yet to see if his Drs are covered but he is not in great health.

I think I would ask him to call the carrier to confirm he has been on the F the entire time.

 

[GreenSky]

Check his meds on blue sky drugs. There are other sites that may work as well.

He may not get all his drugs through Canada but it's worth the time to take a look.

The idea of a diabetic snp is a good one. He can use trial right to get back into a supp and pdp within a year.

Rick

 

[Hopes]

Check his meds on blue sky drugs. There are other sites that may work as well.

He may not get all his drugs through Canada but it's worth the time to take a look.

The idea of a diabetic snp is a good one. He can use trial right to get back into a supp and pdp within a year.

Rick

Thanks for the link. I'll take a look. He's on 19 prescribed meds.

 

[Hopes]

Check his meds on blue sky drugs. There are other sites that may work as well.

He may not get all his drugs through Canada but it's worth the time to take a look.

The idea of a diabetic snp is a good one. He can use trial right to get back into a supp and pdp within a year.

Rick

Even if I change his condition in Medicare.gov to "poor" health, it still shows that costs will be around $1600.

And, I took a quick look at the link. Of four I checked, two were available for a huge savings. I need to spend more time.

 

[somarco]

sliding him to a G plan

IDD + 19 med's. Doubt he will make it through underwriting with anyone other than UHC. . . but he already has them.

 

[Chazm]

IDD + 19 med's. Doubt he will make it through underwriting with anyone other than UHC. . . but he already has them.

I think hopes talking about a trial right in jan

 

[Hopes]

IDD + 19 med's. Doubt he will make it through underwriting with anyone other than UHC. . . but he already has them.

IDD?

My first thought was to see if he would pass UW for a much lower price plan and he didn't.

I went back and checked his age - 75 (apparently I can't count backwards). With UHC a G plan would be $178.50. Still a savings over F....

I think hopes talking about a trial right in jan

Yes, that's what I was thinking.



And, I've looked at the website Greensky provided and the updated information is:

Potential G $714
Blue Sky Drugs $3181.08 (obviously, this is assuming he is comfortable ordering through the website) Most meds were lower here.

 

[somarco]

I think hopes talking about a trial right in jan

Trial right into plan G?

IDD?

Insulin Dependent Diabetic.

With UHC a G plan would be $178.50. Still a savings over F....

He has UHC now.

I assume you are not the agent. He may have bought direct, not even used an agent.

Will UHC pay you for changing him from F to G?