Seniors, can we talk?
The elections are over and all those election ads are gone. The Annual Election Period is still going on and so are all those ads – until December 7. Ruth and her friend, Betty, are reviewing their Medicare Prescription plans. They received their annual notice of change (the packet showing the difference between the current plan and the 2015 version). Ruth has liked her prescription plan this year because it had a low monthly premium and no deductible. In 2015 her monthly premium will increase about $10 plus she’ll have a $320 deductible. Since Ruth is not happy with these changes, she got a list of her prescriptions from her pharmacy to give to her agent. The list also included the dosage and how often she takes each. This is all the information her agent needs to make a personal comparison. Her agent looked at the 28 plans available. Several factors were taken into consideration including premium, deductible, copays, prescriptions covered and if there were any “management” tools. Ruth was not familiar with these so we talked about them. All prescription plans include 3 tools to help manage (reduce) the cost of prescriptions – prior authorization, quantity limits and step therapy. Prior authorization requires the pharmacist to call your doctor because specific criteria must be met before the drug can be filled. Quantity limits are based on approved dosage limits. Step therapy requires that you try certain drugs before your prescription is filled in an effort to try to control the costs. Medications that are most cost effective are tried first and then progresses to others more costly. After looking at all these factors, Ruth found that her current plan will continue to be appropriate and suited for her in 2015 based on her current prescriptions and the pharmacy she prefers. She found that her current prescriptions are all Tier 1 or Tier 2 and the deductible will not apply to any of them. Unless she starts taking a Tier 3 or Tier 4 prescription she will never realize she has a deductible. Betty’s situation is different. Her premium only increased a little and her deductible only changed from $310 to $320 – not much change. When she looked at the prescriptions that will be covered next year, she noticed that one of her prescriptions that is expensive will no longer be covered. Yes, the prescriptions covered by your plan changes every January 1. Betty found another plan that covers ALL her prescriptions and may save her over $550 compared to keeping her current plan. Just because your plan does not cover a certain prescription does not mean that no plan will cover it. Do your homework. Everyone’s situation is different - just like Ruth and Betty. Ruth is keeping her plan and Betty found a plan that will not only save her money but will cover all her prescriptions. You have until December 7. Got questions? Call me at 870-523-6771 and say “Caroline, can we talk?” Originally Published November 2014
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AuthorCaroline Beauchamp specializes in personalized life and health insurance solutions. Archives
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