Sorry, but the World is Not coming to an End

[Medicare bro]

Caveat, not an agent.

Around 3 years ago, I had an agent at a table in the grocery store (think it was UHC) ask if I wanted help with my drug plan. I told him no. He circled around to asking again, when I told him no again and left the table to do my shopping, he had a funny look on his face. I don't know if he needed the commission, if he thought I couldn't do it myself, or what.

I do know he had absolutely no clue what he was asking for.

Dude should of been kicked out of the store for approaching you. That is a big no no.

 

[n3417511]

Nah… the guy had a table there. Walmart agents during AEP. Normally the agents that don’t have a big book of business or newly starting out do it.

 

[just-a-client]

You're wasting your time. KFF doesn't provide details, because nobody knows the answers until the last minute. The govt way.

You have to wait for the initial rule, then comments period, then final govt rule, then interpretations of that rule, and then the interpretations of that interpretation, and then reaction from carriers which is released just in time before open enrollment.

To find out Oct 1st that the website is wrong, RX formularies are wrong, doctor networks incorrect. On and on. I'd recommend not checking formularies until late October if on expensive meds to ensure accuracy.

Yes Q1 is a good resource along with this forum. But going back to wasting your time, I am "Y"agents, there is a reason we exist....so we can spend countless hours learning this chit each day and year so you don't have to.

I've heard that MyMedicare can be wrong, especially early in the enrollment seasons. I think the plans also post their formulary documents on their sites by Oct 1 - the PDFs. That will be revealing, along with the ANOC. I'll be checking for the drugs I take, and just out of curiosity for some of the well-known expensive ones - like Eliquis, which I don't use, but which is often cited here. (And for good reason - I think Medicare pays more for that popular brand drug than any other, and I think it's in the first batch of 10 subject to Medicare negotiations because of that.)

Someone was talking about preferred pharmacies. In 2017, it seemed Walgreens had almost all of that business, and CVS was quoted that they weren't interested in taking losses on the cheap generics in return for volume. But in 2018, it flipped, as CVS got heavily into that business and very few plans stuck with Walgreens. (Cigna and AARP/UHC were exceptions that hung in with Walgreens.) But then I found, surprisingly, that Wellcare was using CVS, and Walgreens, and grocers (like Safeway and other Albertson grocers), and Costco (and probably other big boxes) all as preferred pharmacies. (Not just "in-network" as standard - but literally "preferred.") It's like they were saying to pharmacies "You're in -- unless you're an independent pharmacy." For whatever reason, trying to push out the small guys.

My theory is that the preferred business is bolstered by Electronic prescription prescribing, which I'm sure the PBMs know. Once you list your preferred pharmacy with the doctor, which they all require and confirm again at every office visit, all your prescriptions get sent there. Even the Tier 3 and 4. It's a lot harder than shopping around a printed Rx, and most people are going to assume that the preferred pharmacy is always a better price.

But in fact, I've observed that negotiated prices for the higher tier drugs can vary widely - that preferred prices mostly apply to Tiers 1 and 2 - and obviously that can make a big difference during the deductible phase, or when paying coinsurance. This is a dirty secret! Probably known to many agents, but not to the typical beneficiary. It always pays to price out drugs in advance and transfer prescriptions to the best locations. Express-Scripts.com has a fantastically comprehensive drug finder/pricer, and Caremark.com's is -- quite adequate, does the trick. They are accurate. I mean, when they price out a drug, they are going through the same back-end logic that is going to price the drug at the retail counter.

And of course as so often noted here, there are times when GoodRx is best of all. I've used it, and costplusdrugs, when they are cheapest.

According to what was posted here, Wellcare is sticking with "CVS, Walgreens and select groceries" again in 2025. Don't know if that will include big box stores, but if you think of them as grocers, which those retailers all include, then very plausibly.

I would happily use an agent, but would never want to take up their time given how little I can see that the PDPs pay them. Not unless I was sure they were going to get my business. I would volunteer at the local SHIP, but I'm afraid I would drive average people who were seeking clear guidance crazy! They'd walk out more confused about their choices than they walked in.

I don't know how you folks sort through all of it for customers, knowing all the facts that you do, but which are too hard (and time-consuming) to really share. It takes some confidence to situate people in plans that can have such a big impact on their lives.

 

[n3417511]

ok! You know too much so my guess is that you work for CMS or you were a pharmacist. All the above we agents do. When a member is penny less and we know they have some high priced drugs, we immediately pull out patient assistance programs and or if they aren’t eligible for that, we absolutely tell them to use a cheaper pharmacy for the meds so they can stretch out the length of the cat stage. We make sure to look at every resource possible to help them. A lot of the tier 4 drugs don’t need to be submitted to insurance Good RX is amazing at times. It all depends on the situation but YES we all do this to help the member.

I do think you are focusing on the past here. The whole drug program is changing now. There will be new ways to help seniors out.

 

[just-a-client]

No, I was just a software developer, and have had a lot of time on my hands. Read this forum a lot, read through the Evidence of Coverage documents, used the old plan finder and the current one at Medicare, set up a spreadsheet every year to evaluate the PDP plans, and do find it interesting. (Most people would rather do anything else in their spare time.)

Part D is going to be a hell of a lot easier to understand - for everyone. New enrollees will never know the confusing "phases" mess. It'll just seem similar to any under-65 plan they've ever known. The MAPD plans will then look exactly like employer-based HMOs and PPOs.

My conspiracy theory is that the Part D provisions in the Inflation Reduction Act were written by revolving door lobbyists who have set it up so that Part D standalone plans will be even more expensive vs. MAPD plans than they already are. Between Part D and supplement premiums, Original Medicare is going to eventually be priced out of existence.

 

[n3417511]

The structure is easier to understand but harder for an agent to really know what the out of pocket expense will truly be on a more expensive plan verses the basic plan. We can’t determine how much the insurance company will apply to 2k. I would say that could be something you can develop for us.

 

[MedicareWAA]

I am not trolling or spreading FUD, I think I have been posting here long enough to show that I am not a fear merchant, I was just sharing what I was told. Believe me or not, that's fine by me..

I don’t believe you’re spreading FUD. Just that you don’t know what you’re talking about. Go find better sources.

Walter

 

[MedicareWAA]

I will lose $40000.00 due to lower renewals but at least I will still have access to the quoting software I never use along with countless, worthless emails. Win, win.

!!! Don’t forget about how this is good for the “ecosystem”, whatever that means. We get quoting software and emails AND a solid ecosystem??? Hat trick!!

Walter

 

[Midlevel]

I guess I’m shocked more agents aren’t pissed. Plan to move my contracts to an FMO who didn’t sue to get our commissions cut. I know those FMO’s are limited due to the monopoly going on in our business sector. Guess we are supposed to just sit back and take it in the ass.

 

[hockeyday]

I guess I’m shocked more agents aren’t pissed. Plan to move my contracts to an FMO who didn’t sue to get our commissions cut. I know those FMO’s are limited due to the monopoly going on in our business sector. Guess we are supposed to just sit back and take it in the ass.

I with you if I can find one I would also move