Medicare drug plan changes a win for patients, taxpayers
February 15, 2014, 08:00 am
Medicare drug plan changes a win for patients, taxpayers
By B. Douglas Hoey, RPh, MBA
Overshadowed by the daily drumbeat of news concerning the Affordable Care Act, Medicare has outlined several enhancements to Part D prescription drug plans (PDPs) that would address bipartisan congressional concerns, give seniors more choices and reduce the program’s costs by an estimated $1.3 billion over five years.
Seniors will benefit in several ways from the proposed rule issued by the U.S. Centers for Medicare & Medicaid Services (CMS).
First, Medicare’s proposal offers more choice of pharmacy for the same co-pay. Currently, whether they like it or not, many seniors are steered toward those pharmacies that their drug plan has arbitrarily deemed “preferred pharmacies.” The excluded, non-preferred pharmacies are contractually obligated by these drug plans to charge higher co-pays. CMS is proposing letting any pharmacy willing to accept a drug plan’s terms and conditions (including reimbursement rate) to offer “preferred cost-sharing”. Seniors would have greater choice among pharmacies at no added cost. This will particularly benefit seniors in underserved rural areas that often include an independent community pharmacy, but from which the nearest preferred pharmacy may be 20 miles away or more. Medicare officials concluded that this approach is “the best way to encourage price competition and lower costs in the Part D program.”
Second, Medicare’s proposal would let more seniors choose between community pharmacies and mail order ones without penalty. Many seniors prefer talking to a pharmacist face-to-face when they want to, rather than waiting for drugs by mail and dealing with 1-800 call centers. CMS proposes to eliminate some higher co-pays for seniors who prefer to use a community pharmacy, many of which provide same-day, home delivery. This change is also budget-neutral, because Medicare data has shown that mail order is often more expensive for Medicare and taxpayers than local pharmacies.
Third, Medicare’s proposal would give more patients access to cost-saving medication therapy management (MTM) consultations with pharmacists.CMS suggests expanding the eligibility criteria for MTM consultations. These in-depth medication reviews have been shown to help improve health outcomes and reduce overall medical costs by improving adherence to prescribed medication and avoiding costlier treatments, such as hospitalizations.
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http://thehill.com/blogs/congress-blog/healthcare/198487-medicare-drug-plan-changes-a-win-for-patients-taxpayers
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that somehow makes everything different. They have Blue Cross/Blue Shield NC for their supplement, so BCBS pays everything Medicare doesn't pay....plus, somehow, their drugs.
It's making me crazy, because I don't have a clue what I'm talking about. 
I just printed out your post, and bookmarked this thread. I'll look into it with this little cheat-sheet you just gave me! It helps! Thanks!
husband did in January. We went through the process of transitioning off of my husband's employer supplied health insurance. He is retired (for three years) but we were able to continue the insurance through CIGNA taken out of his pension payment each month. We were looking forward to getting on Medicare because the CIGNA cost $878.00/month for the two of us. We had health insurance, vision plan and dental for that price.
When I got ready to start looking at Medicare and a Supplemental for what Medicare does not pay, plus the other plans for vision and dental, I was referred to a company provided by my husband's employer. We also are supposed to each receive $85.00 a month from his former employer to go toward our health insurance expenses. (One of his retirement benefits.)
To say it was confusing is an understatement. There was a website to get registered and then we could see the Medicare Supplemental plans all grouped together for our state. We also could see Medicare Advantage Plans grouped. Remember, each state is different. So there are many, many plans but what is relevant is WHERE you live. What your cousin has in Wisconsin will not be pertinent to your situation unless YOU live in Wisconsin. You have to look at the policies that are approved in YOUR state and for your circumstances. So where you live matters and if you smoke or not matters when it comes to the final cost per month for your supplemental insurance.
And yes, you are so right to look carefully at the differences between Medicare Advantage and Medicare with a Supplemental. There are differences between them and at first glance, you may think one way over the other may make sense for your situation. But do ask questions and read EVERYTHING. Not just the plan summaries on a web page. Get a look at the entire plan and be sure you understand what it means for you. It is not all about how much you pay each month. Find out what you get for that premium and what you do NOT get. Or what the rules and limitations are.
And one last caveat: Do not wait until the last minute to start the process. This is complicated and can be confusing even with help. Don't make a snap decision about which way you'll go because you could make a costly mistake. Or one that causes you distress, such as not being able to see the doctor you've known and trusted. I called my doctor's office and made sure they accepted and participated in the plan I was considering. And at times I felt positively STUPID for getting confused but realized that the way it is set up now....it's just the nature of the beast. It could be easier but until we deal with the whole way we provide health care and health insurance in this country, it's the system we have. I ended up choosing Medicare A & B, United Health Care Plan F (AARP) and Wellcare for drugs and a Humana Plan for dental. I made no decision regarding a vision plan but can change my mind about that later.
Oh and I just thought of one more thing....when I signed up in August I calculated the cost and didn't realize that by the time I got completely enrolled, the cost would go up for my plans. Not by a lot but when you're on a fixed income, every increase matters. So if you sign up late in the year like I did, you may find a raise in the rates is quickly applied to your rates when the new year comes around.
They never told me that the rates I was quoted would likely change in pretty short order.