Question on Employer Lifetime Drug Coverage Retirement Benefit and Medicare Advantage Rx

[Fisher]

GoodRx is not creditable drug coverage. It's not even drug coverage, it is a discount plan.

That is true, which we both understand. It is also not the point, which we also both understand. It does make a handy deflection for you, though.

 

[rmhaire]

That is true, which we both understand. It is also not the point, which we also both understand. It does make a handy deflection for you, though.

What am I missing? What is he trying to deflect?

As for the correct answer to the OP's question, you can have both.

Drug coverage is no different than any other plan. Supp, MAPD or ACA. You'll have primary and secondary which will be based on the number of EE's in the group plan.

 

[goillini52]

Lol lie? There is nothing anywhere that dictates what Rx coverage a Medicare beneficiary must use in a situation like this. When you advise a client to use GoodRx instead of their PDP, is that lying?

On my last PDP, I could get a Pro Air inhaler using GoodRx for about half of my PDP's $47 copay. I've changed plans and now I have no copay.

 

[LostDollar]

Thanks for the response. They will use the retirement drug plan. They have been retired for several years and use their retirement drug plan. Once they get the new plan, the pharmacy will only have their retirement drug plan on file, as that's how it works now. I had a client four years ago with the same retirement drug plan and enrolled him in a Medicare Advantage HMO Rx plan. He was in it for a year and had no problems. He got all his prescriptions through the retirement plan, not the HMO Rx plan.

So, in other words, they will lie about their coverage.

Lol lie? There is nothing anywhere that dictates what Rx coverage a Medicare beneficiary must use in a situation like this. When you advise a client to use GoodRx instead of their PDP, is that lying?

GoodRx is not creditable drug coverage. It's not even drug coverage, it is a discount plan.

That is true, which we both understand. It is also not the point, which we also both understand. It does make a handy deflection for you, though.

I am not sure you understand somarco's point.

In the cases of Health Insurance and Dental Insurance, if an agent tells a client not to provide all their coverage information to a provider, they are telling the client to commit insurance fraud.

I don't know if the same thing applies to Prescription Drug Coverage. I also don't know if having Medicare Part C or Part D coverage precludes a person from having or using other prescription drug coverage. If there are any grey areas there, the agent is exposing themselves to a risk of being charged with encouraging a client to commit insurance fraud. The agent is putting their license and career at risk based on the actions of another individual whom they cannot control. Both deliberate and accidental use of a second drug plan WHICH IS NOT SUPPOSED TO BE USED, could happen during a plan year.

From reading here, I know there are spiffy commissions for an agent from MAPD plans, but it seems to me like this situation poses a risk to the agent which they would do well to avoid.

That is just my non-agent view from the sidelines.

 

[rmhaire]

I don't know if the same thing applies to Prescription Drug Coverage. I also don't know if having Medicare Part C or Part D coverage precludes a person from having or using other prescription drug coverage.

All depends on two words. Credible Coverage. If it's not considered credible then it doesn't count. And since discounts programs are not considered credible, the insured can have as many as they want.

But PDC is considered credible, regulated by CMS and you can only have one.

 

[ValeRosso]

All depends on two words. Credible Coverage. If it's not considered credible then it doesn't count. And since discounts programs are not considered credible, the insured can have as many as they want.

But PDC is considered credible, regulated by CMS and you can only have one.

So is this a nationwide thing? Because I've run into more than one person with both a employer group plan which includes Rx, also with a medicare PDP. I thought this is the same as having a primary and secondary payer just as it is with medical insurance.

 

[somarco]

I also don't know if having Medicare Part C or Part D coverage precludes a person from having or using other prescription drug coverage.

PDP applications ask if you have other prescription drug coverage that you are keeping in addition to this plan?

 

[somarco]

So is this a nationwide thing? Because I've run into more than one person with both a employer group plan which includes Rx, also with a medicare PDP. I thought this is the same as having a primary and secondary payer just as it is with medical insurance.

https://insurance-forums.com/commun...nd-medicare-advantage-rx.111011/#post-1461546

 

[rmhaire]

So is this a nationwide thing? Because I've run into more than one person with both a employer group plan which includes Rx, also with a medicare PDP. I thought this is the same as having a primary and secondary payer just as it is with medical insurance.

I was talking about PDP and discount cards. I never mentioned group coverage.

Yes you can have group Rx and a PDP. Who pays first will depend on the 20EE rule just like Medicare and ACA.

So, you can Group Rx, a PDP and 27 discount plans if you want. You just can't have 2 PDPs.

 

[Fisher]

I don't know if the same thing applies to Prescription Drug Coverage.

That is correct; you don't.