In NC all the UHC plans have a $47 copay for tier 3. They also still have a copay for tier 4. Now all have a deductible for tiers 3-5 which they didn't have last year.
The best graph I’ve seen breaking down new part D but very complicated
- Thread starter DonP
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UHC seems to have the 0/12/27/100 copays on most plans nationwide with a $295 to $590 deductible .
I just checked and UH does have the $47.00 copay. Did away with their dental though other than cleanings and exams and are no longer $0 premium.
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unfortunately for those that have a big uhc book the 47.00 tier 3 doesn't stand out as a positive like the no dental stands out as a negative in the ANOC and on the flip side the Aetna 24% tier 3 may not mean much to consumers but they will feel the sting in january and then go shopping.I wonder how they calculate the troop transfers if they change from aetna to uhc in january for February 1?
According to Aetna rep the troop transfers but the smoothing payments do not. She talked about the scenario of someone taking expensive drugs in January and February and signing up for payments through Aetna and then switching to UH 3/1/25. Aetna is still responsible for collecting the money from the client after they move. We all know how that's going to turn out.
That is a good question to get answered. That absolutely sucks for the Original Ins Company, aetna in this scenario
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Remind me, what's smoothing, the payment plan?
Yes
I don't think this is right and its also where I got confused in June.
Here's a cut/paste of an email from Medicare Answers Now to/from CMS.
Thank you for your question. Please see our response below and the attached document for further clarification:
The 2025 diagram is only intended to show the breakdown of costs between the plan, manufacturers, the government, and beneficiaries in each benefit phase all in one graphic.
The bold black line represents the beneficiary’s true out of pocket (TrOOP) limit in 2025. In 2025 when the beneficiary’s accumulated TrOOP reaches $2000, the manufacturer discount payments change from 10% to 20%. Neither the manufacturer discount nor the sponsor’s portion of the costs under the defined standard benefit count towards the beneficiary’s $2000 out of pocket costs.
For a detailed discussion of costs that count toward TrOOP in 2025, please refer to Section 30 of the Final CY 2025 Part D Redesign Program Instructions and the August 5 HPMS memorandum entitled “Clarification of True Out-of-Pocket Costs for Calendar Year 2025 – Revised” (attached).
Thank you,
Cristina
Here's where I am at. Assuming the grid is wrong, every Medicare Part D person (Standalone OR MAPD) has a $2K gift card. Once they spend the $2K, they will pay $0 the rest of the year.
Here's a cut/paste of an email from Medicare Answers Now to/from CMS.
Thank you for your question. Please see our response below and the attached document for further clarification:
The 2025 diagram is only intended to show the breakdown of costs between the plan, manufacturers, the government, and beneficiaries in each benefit phase all in one graphic.
The bold black line represents the beneficiary’s true out of pocket (TrOOP) limit in 2025. In 2025 when the beneficiary’s accumulated TrOOP reaches $2000, the manufacturer discount payments change from 10% to 20%. Neither the manufacturer discount nor the sponsor’s portion of the costs under the defined standard benefit count towards the beneficiary’s $2000 out of pocket costs.
For a detailed discussion of costs that count toward TrOOP in 2025, please refer to Section 30 of the Final CY 2025 Part D Redesign Program Instructions and the August 5 HPMS memorandum entitled “Clarification of True Out-of-Pocket Costs for Calendar Year 2025 – Revised” (attached).
Thank you,
Cristina
Here's where I am at. Assuming the grid is wrong, every Medicare Part D person (Standalone OR MAPD) has a $2K gift card. Once they spend the $2K, they will pay $0 the rest of the year.
$2k gift card? I can see the FB ads already generating…
It’s sort of wild that CMS and and the carriers can’t make sense of this to the agents…. But the agents are expected to make sense of it to the beneficiaries, and the kicker, we won’t get paid for it on the PDP. And we gotta do it with all the new compliance, in a 53 day window.
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