Newbie Question:need Help, New Deductible if Transfer RX Mid Year, See Message

[yorkriver1]

Client T-65 in Feb 2014. Has had MAPD since qualifying for SSDI November 2013.

Told client really should consider med/supp + PDP after T65, due to potential high OOP's for medical condition and need to take advantage of GI on Medsupp.

Now I have questions about new RX plan that shows as best option both on the carrier's site and on Medicare.gov.

It has the $310 deductible. I have been told that their gap coverage travels from one plan to the other if they switch mid year.

Prior MAPD has no deductible.... will there be a deductible if client is already in donut hole for 6/1/14 effective date?

 

[goillini52]

Client T-65 in Feb 2014. Has had MAPD since qualifying for SSDI November 2013.

Told client really should consider med/supp + PDP after T65, due to potential high OOP's for medical condition and need to take advantage of GI on Medsupp.

Now I have questions about new RX plan that shows as best option both on the carrier's site and on Medicare.gov.

It has the $310 deductible. I have been told that their gap coverage travels from one plan to the other if they switch mid year.

Prior MAPD has no deductible.... will there be a deductible if client is already in donut hole for 6/1/14 effective date?

I don't do MA/MAPD/PDP's anymore, but I think the deductible and the donut hole are with each carrier, unlike Part B's deductible. Of course I could be wrong. Then again, I might be right. I'm pretty sure it's one or the other.

 

[somarco]

I'm pretty sure it's one or the other.

Covering your bases . . .

The Rx deductible is per plan and doesn't carry over to a new plan. He is still in his initial enrollment period so the transition from MAPD to Medigap isn't an issue.

Moving to a PDP may work to his advantage, at least for this year. Even with the deductible he may delay (or even eliminate) going into the donut hole in 2014.

All this is moot if golini is wrong.

 

[yorkriver1]

Well, we're about to find out...just wrote new PDP because switching to med/supp from MAPD was the right thing to do. 2 different carriers told me that cost of drugs already paid on PDP's carries over . Probably have to pay deductible on new plan. Still overall cost with new drug plan is good.
Lots of drugs, but never going to qualify for GI med/supp. Can always go back to MAPD....

 

[somarco]

2 different carriers told me that cost of drugs already paid on PDP's carries over

.

That's a neat trick but I have no idea how they would track it. Rx doesn't run through Medicare. It goes through the carrier or PBM.

 

[yogooglethis]

Client T-65 in Feb 2014. Has had MAPD since qualifying for SSDI November 2013.

Told client really should consider med/supp + PDP after T65, due to potential high OOP's for medical condition and need to take advantage of GI on Medsupp.

Now I have questions about new RX plan that shows as best option both on the carrier's site and on Medicare.gov.

It has the $310 deductible. I have been told that their gap coverage travels from one plan to the other if they switch mid year.

Prior MAPD has no deductible.... will there be a deductible if client is already in donut hole for 6/1/14 effective date?

In this case I would see on medicare.gov where where her current mapd rx costs, initial coverage usage etc.( at her preferred pharmacy because many plans have preferred pharmacies that can make a big differences in cost ) are at up through end of May so when you switch her there is no big surprises.

To determine the best pdp plan mid year I use the " rest of year cost " comparison instead of "annual cost" comparison for a more valid comparison.It can make a big difference especially if one plan has a deductible and the other doesn't

 

[WCMason]

To determine the best pdp plan mid year I use the " rest of year cost " comparison instead of "annual cost" comparison for a more valid comparison.It can make a big difference especially if one plan has a deductible and the other doesn't

Good advice for any plan comparison where the effective date is any month but January (and good even then). I would prefer the PlanFinder tool default to remainder of the year instead of the current full calendar year

 

[yorkriver1]

OK, third source, a website has helped. The site markets based on giving tons of Q&A in depth info about how Medicare plans work. They confirm that TROOP carries over from one Medicare D plan to another in a mid year change.

Deductible on new plan vs. none on old? Still a bit murky, but the #'s still work out however the $310 does/doesn't get applied.

Medicare does track the RX usage/TROOP.

Now, let's see if new plan gets the info. transferred to them PDQ or not...

This is not my usual beat or anything I am soliciting specifically, but a client with the serious situation mine has is best getting into a med/supp stat at T65. Client is eligible for "IEP 2" (turning 65 after 1st qualifying for SSDI before age 65).

Thanks all for input. Looking at how the costs transition before/during/after gap is helpful in estimating what will happen 6/1 thru 12/31/14. Client looked on current carrier's website where she signed up to track her plan, saw $ applied to gap so far.

If it ever makes sense, client can always go "back" to an MAPD, but best take the no med question supplement for now.