Phil Castell
Castell Insurance
426 E. Washington St., Sequim, WA 98382
Phone: 360-683-9284 • Fax: 360-683-9026
Phil@CastellInsurance.com
www.CastellInsurance.com  

 

Last month I talked at some length about the changes that would be occurring with the Medicare Advantage Plans for 2010. Today I will explain changes in the ever-popular Medicare Part D programs for 2010.

You must read very carefully any letters or packages you receive from your insurance company. Check that all your medications are listed in the formulary and that you understand how the co-pays and deductibles will work.

If you need help, free assistance always is available from the following:

Medicare at 800-633-4227; SHIBA at 452-3221 (they also hold free clinics at the Sequim Senior Activity Center from 10 a.m. to noon each Tuesday), or your local insurance agent.

I also find the www.

Medicare.gov Web site to be useful for those who are comfortable using a computer.

Many people do not bother to wade through all the fine print, but you should. If you do not, you may regret it for all of 2010.

For 2010, the number of plans offered in Washington state has dropped to 44 and, of these, a couple of plans are not open to new enrollees but allow current clients to keep their coverage if they choose.

The biggest change is the sharp drop in number of plans offering with zero deductibles, from 27 plans in 2009 to 16

plans in 2010. More than 60

percent of the programs will have deductibles ranging

from $50 to $310 in 2010.

The lowest plan available costs $8.80 per month from First Health. It is available only directly from the company. It has worked fine for persons who take no medications at all and just want to be in the Part D program to avoid penalties at a later date.

The Humana Standard PDP (to be replaced) cost only $6.93 four years ago. That premium has climbed rapidly to more than $30.

The new lower-cost Value plan from Humana, has a premium of $18.60 per month, but the formulary - the list of covered medications -- is not so comprehensive. For example, it does not cover the cholesterol medication Lipitor. So, if you enrolled for the low premium but you took Lipitor, you would pay 100 percent of its cost.

Speaking of Lipitor, I have completed a little research on that one medication on the 42 plans available for 2010. These plans are offered by 17 different companies.

Of these 17 companies, at least five of them offer plans that do not cover Lipitor. These five companies are Humana, Unicare, Sterling, United American and EnvisionRx.

Let's go one step further. By now everyone is aware of how the insurance companies classify medications in different "tiers." This is primarily how much your co-pays will be. Consider the following.

Lipitor is as follows with these companies:

Humana Enhanced Plan, Tier 2, $45 co-pay

Aetna (Costco plan) Tier 3, $33 co-pay

Coventry Premier Plus, Tier 4, $90 co-pay. Based upon a percentage of retail.

Group Health, tiers and co-pays vary depending upon strength of dose.

The formularies all are different, as are the co-pays; a Tier 3 with Aetna is less costly than a Tier 2 with Humana.

Things definitely are getting far more complicated.

Regarding tiers, most companies in the past have had four basic tiers. Tier 1 for generics, Tier 2 for preferred brand, Tier 3 for nonpreferred brand and Tier 4 for speciality drugs.

Many companies have expanded that to five tiers, and CVS Caremark Plus has six.

In the case of CVS Caremark, they have enhanced benefits if you shop at a CVS drug store or purchase online. They have one store in Washington and it isn't on the peninsula.

Humana and Aetna offer plans that have a $0 co-pay if you purchase a 90-day supply via mail order. Did I say purchase? How can you purchase something for nothing?

The surprising thing is that the Aetna plan that offers this tremendous benefit is the Costco branded plan. The other two Aetna plans do not even give a discount if you order generics via mail order.

So, I wonder if the genius at the Costco headquarters who signed off on a Costco-branded product that actively encourages people not to visit the store will find he or she will be promoted or fired. Any comments?

As always at this time of year, I urge people to take care and read all the material you receive from your insurance plans.