PDP for 2010

[Tom Highway]

I know that most of you who sell med supps don't sell PDPs, and that's fine.

In looking at the 2010 PDP availiability in my area, it seems that the prices have gone up pretty significantly, or coverage has gone down. The lower price PDPs (less than $60 per month) have a deductible of anywhere up to $350 per year, and none of them have any coverage in the coverage gap.

The higher price PDPS (over $60 per month) typically have no deductible, and cover some generics in the coverage gap.

As near as I can tell, the plans are not quite as good as they were in 2009 because of some reimbursement issues to the plans themselves.

So my question is, if you sell med supps, how do you think the 2010 PDPs will impact the supps? How do you think the overall comparison of MAPD vs Med Supp with PDP will change?

 

[captain94]

In my are Mapd are around $80 a month with 5K to 6K MOOP. so if you consider the MOOP the co-pays and the cost of say a G Plan (around $90) the Medsupp is a better buy even with a PDP.

 

[Tom Highway]

In my are Mapd are around $80 a month with 5K to 6K MOOP. so if you consider the MOOP the co-pays and the cost of say a G Plan (around $90) the Medsupp is a better buy even with a PDP.

Wow. Ohio is not like Alabama, I guess. We have several $0 premium MAPD plans with aound $3k MOOP. Most of the MAPD plans in the $80 a month premium range have very low or $0 copay.

 

[Cenla Agent]

Coverage in the coverage gap is hard to find, other than for home infusion drugs. Typically the plans that I see that offer some coverage in the gap are MAPD plans, and in most cases that's for some generics and not brand name drugs.

I don't know anything about other states and can only speak of my experience here. It looks like there is more variation now. Iin years past typically the same plans would often be offered in every state, with only the premiums being different.

In 2006 Humana had the "Complete" plan which had no gap (i.e. covered both brand names and generics in the coverage gap) and was a pretty good deal for those whose cost warranted it. However, the next year it only covered generics in the gap and benefitted hardly anyone. (I wonder how many people have remained on that plan and others that no longer benefit them as well as other plans would.) In 2007 Sierra had a no gap plan, but it was very expensive (something like $120 per month in Louisiana) and IIRC had a pretty weak formulary. I don't know of any plans since then that have covered both brands and generics in the gap.

 

[jdeasy]

I know that most of you who sell med supps don't sell PDPs, and that's fine.

In looking at the 2010 PDP availiability in my area, it seems that the prices have gone up pretty significantly, or coverage has gone down. The lower price PDPs (less than $60 per month) have a deductible of anywhere up to $350 per year, and none of them have any coverage in the coverage gap.

The higher price PDPS (over $60 per month) typically have no deductible, and cover some generics in the coverage gap.

As near as I can tell, the plans are not quite as good as they were in 2009 because of some reimbursement issues to the plans themselves.

So my question is, if you sell med supps, how do you think the 2010 PDPs will impact the supps? How do you think the overall comparison of MAPD vs Med Supp with PDP will change?

They took a big jump here as well. The lowest cost plan without a deductable for '09 was Advantra Value at $24/mo. That plan goes to $32/mo for '10 with, best i remember, a $100 deduct.

The lowest coast plan with no deductable for '10 is Aetna at about $33/mo. I was looking some of these up for a client a week or so ago and that's what I was running across. He takes no meds now, so, there was no formulary items to make sure were covered. I had a Humana agent tell me that Humana was gutting their formulary for '10 and raising prices significantly.

I helped the guy get into the Advantra with an effective date of 11-1, {he just turned 65}, and I will help him change to the Aetna for 1-1-10.

There are about 10 less plans available here for next year. Still, with 42 plans available, it's a huge maze for the consumer.

 

[GreenSky]

The lower price PDPs (less than $60 per month) have a deductible of anywhere up to $350 per year, and none of them have any coverage in the coverage gap.

Just to keep things "honest," the deductible can be no more than $310 this year.

Rick

 

[Tom Highway]

Just to keep things "honest," the deductible can be no more than $310 this year.

Rick

Sorry, was going from memory.

 

[Dowejonez]

I helped the guy get into the Advantra with an effective date of 11-1, {he just turned 65}, and I will help him change to the Aetna for 1-1-10.

If the guy took no meds, why didn't you just wait and write him up for Jan 1?

 

[jdeasy]

If the guy took no meds, why didn't you just wait and write him up for Jan 1?

He didn't want to wait, But, I didn't write him up anyway. I helped him get on line and enroll himself. I don't write PDP anymore. I'll help him change to Aetna later. He has his med sup with now and 3 life policies in home. I can take a few minutes to help him with his PDP.

 

[insurance0707]

I've been running medications for the last two weeks for my clients for 2010...basically for free. In Mi the two plans that consistantly show up are.....

First Health 16.60 a month $175 ded

Aetna $33.90 $0 ded $ 2 copays generic $ 0 copays if they use mail order on generic

AARP comes up alot also.

Some of the MAPD plans or PPO plans are adding $310 ded where they didn't have them before. Humana's PPO plan had a $310 ded. I don't know if it's all of their plans but the one that i looked at yesterday online had a ded.