Part D coverage gap and changing plans

[jack3454]

Say someone has a standalone PDP and is in the coverage gap. Then they change to a MAPD during the same year. Do they stay in the same Part D phase? If so, is there any way to calculate the drug price with the new MAPD plan knowing you can't use the data on the drug price lookup (since that shows copays as if they just started with a clean slate)?

 

[straightnochaser]

Say someone has a standalone PDP and is in the coverage gap. Then they change to a MAPD during the same year. Do they stay in the same Part D phase? If so, is there any way to calculate the drug price with the new MAPD plan knowing you can't use the data on the drug price lookup (since that shows copays as if they just started with a clean slate)?

Drug coverage continues as is, they wouldn’t start over. What do you use to run drugs? I typically just go to the month they’re starting the new plan and give them an estimate.

 

[jack3454]

Drug coverage continues as is, they wouldn’t start over. What do you use to run drugs? I typically just go to the month they’re starting the new plan and give them an estimate.

I use Sunfire.

So if they're in the coverage gap and change plans, they pay up to 25% of the drug cost still...would they still be paying the same price they paid when they were in the coverage gap while in the PDP vs the new MAPD plan?

 

[Ronnie Carter]

I use Sunfire.

So if they're in the coverage gap and change plans, they pay up to 25% of the drug cost still...would they still be paying the same price they paid when they were in the coverage gap while in the PDP vs the new MAPD plan?

Should be about the same, but be aware that different plans (not to mention different pharmacies) can have varying total drug costs, on which the 25% is calculated. For instance, a drug such as Eliquis might have a total cost of $950 for a 30-day supply, and $875 with another, resulting in different coinsurance amounts. The Medicare plan finder is sometimes erroneous with these total drug costs, at least as compared to real-world purchases at the pharmacy.

Despite all the problems, it will be nice for many beneficiaries to be rid of that hated donut hole next year.