What would you advise this guy to do?

Sep 6, 2007

  1. senior-advisor-indiana
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    I have a guy that has a med supp that he pays for himself. He also pays for a major med through his former employer that has a 5K ded and $10 co-pay for prescriptions.

    He is 75 and is on 3 prescriptions. 2 are generics and 1 is lipitor. So a Part D plan will cost him around $30 per month(avg) and the cost for the generics will be $0-$10 and the cost for the lipitor should be between $20 and $40. I can save him on the supp so I am not worried about that. Should he drop his employer coverage and take the Part D plan? His employer plan is costing him $130 and he is only using that plan for the Rx.

    The part D plan will save him now about $60 per month. But if he gets prescribed more he will definetly regret it. I would never ever tell him to drop that plan. It is defenitly up to him but I think I am going to advise him to keep the employer plan. What would you do?
     
  2. senior-advisor-indiana
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    Actually it will save him about $100 if you include is rx co-pays also, Sorry my math is a lil off.
     
  3. GreenSky
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    There is no need to keep the employers plan unless you think Part D will be ended when Ron Paul is elected President.

    Seriously, he should drop the employer plan and go with Part D. Although he'll have a doughnut hole, he will also be $1,200 ahead so the actual "hole" only really starts at about $3,800. (Does that follow?)

    Do a quick search on the net for the best Part D. Some are only $20 for brand (UHC).

    Rick
     
  4. midwestbroker
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    Find out if he leaves the employer plan, can he get back in. Some let you, others do not.

    Also, can he have a part D plan with the group coverage. Probably no, but worth the call to find out.

    So, he is spending $160 per month on drugs including premium with the group but has no coverage gap (I assume).

    With a Part D plan, he would be spending approx $80 with premium (give or take) with a gap.

    I have had people in this situation and I tell them if the extra premium is not hurting their check book and/or is worth their piece of mind, then keep it the way it is. If his situation ever changes, he will have a SEP and get a drug plan anytime.
     
  5. senior-advisor-indiana
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    Why would he want part D with the group coverage? He only has the group plan for the Rx, the medical side is worthless too him.

    Greensky, even if I can save him $100 a month he is still gonna be pissed off in 2 years if he gets prescribed 6 more brand name Rx. I do not like these situations. I normally just leave employer plans be, the ones with Rx coverage, unless they are just outrageous in price.
     
  6. midwestbroker
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    That is what you call posting without rereading. Never mind the Part D with the group coverage comment.
     
  7. policy doctor
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    You didn't say if his drug copays are part of the 5k deductible, or does it stand alone. If they're part of the plan, find him something that will help with the initial 5k deductible, like an indemnity or those wrap around plans.

    See if his plan would coordinate with an MA.

    Is that 5k deductible a one-time deductible, or annual?

    You need to state your case more clearly.

    BTW...is the client concerned about the initial dedcutible or can he afford it?
     
  8. senior-advisor-indiana
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    Sorry, I assumed the deductible is annual. I did not ask the client but I am 99.99% sure it is annual. I am not sure if the Rx co-pays count towards the deductible. With a $10 co-pay he woud have to get 500 refills in a year to meet the deductible. If it did than that would be a no brainer. Policy Doc....you seem to be the only one that didn't get my question?There isn't much to this situation. It boils down to a gamble.
     
  9. policy doctor
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    Great...so now you figured out the answer, right?
     
  10. senior-advisor-indiana
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    I had my answer before I asked. I just wanted to see what you guys would do.
     
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