To complete the evaluation for finding my mom’s cheapest Medicare Part D plan (see BB’s Medicare Open Enrollment: Stand-Alone Prescription Drug Plans ), I will narrow down the selection by looking at the plan details for the two cheapest Medicare Part D plans on my mom’s list (Wellcare Classic or SilverScript Choice). We will be using the information on the government’s Medicare Plan Finder database. These two plans are shown in the figure below.
The cheapest Medicare Part D plan (i.e., the one with the lowest potential out-of-pocket spending) is obtained by matching the plan’s design (formulary/cost structure) with my mom’s particular drug needs. The cheapest Medicare Part D plan will always be the plan that shows a YES besides All Your Drugs on Formulary in the figure above. Any prescription drug not on a formulary will have to be paid by the consumer since the plan deos not cover it. If you see a NO, you can click on it to see what drugs are not on the plan’s formulary. If a particular drug is not on many formularies, then you might want to ask your doctor why he/she prescribed it rather than others that are on your formulary. Be aware that some drugs have no substitutes.
In my evaluation, I do not simply take the cheapest Medicare Part D plan. For example, I need to investigate whether saving $130 for the year is worth dropping to a 2.5 star rating (from a 4 star rating). In addition, plan design differences could spell trouble if drug needs increase next year. Changing to the cheapest Medicare Part D plan (my mom presently has the SilverScript Choice plan) also requires signing up and having new prescriptions written for a new mail order company.
Evaluating The Cheapest Medicare Part D Plans in Detail
If we click on a particular plan name in my mom’s list, we will be greeted with the following webpage:
I will be looking at the information found under three tabs–Overview, Drug Costs & Coverage, and Star Ratings. Note the Return to previous page tab at the top because I use it frequently to get back to my original list of plans so that I can pick another plan to evaluate in detail. I also might select Update Search (top right) so that I can change my pharmacy choices.
In the Overview window, there is a link to the company’s website (as shown below). This is where I have to go to get a particular plan’s 2017 Summary of Benefits, Evidence of Coverage, and Formulary documents (usually downloadable as pdf files). In the company’s document page, you might also find addition documents that you might want to look over (e.g., appeal process documents). The Summary of Benefits outlines plan benefits and costs and should be looked over for all plans under serious consideration.The Evidence of Coverage document which defines the plan coverage in detail should be downloaded and saved for the plan chosen.
Most of the information about a plan is found under the Drug Costs & Coverage tab. Under this tab, you can see the breakdown of your costs by drug and by month. I have checked the two cheapest Medicare Part D plans and selected Compare Plans to get side-by-side information. The data under Estimated Monthly Drug Costs is shown below:
As usual, I have blacked out all drugs except the first in my mom’s list for privacy. Remembering that SilverScript is owned by CVS Health, it is interesting to note that the full costs of all drugs are lower in the Wellcare Classic plan. I can display the information for either a retail pharmacy in my list or for mail order at the top of the web page.
Returning to the main page I can also view the cost data in bar chart form. I simply click on the graph (labeled 2 above) and the following information for my two cheapest Medicare Part D plans will be displayed as a separate tab.
Selecting the cheapest Medicare Part D plan gets a bit complicated (surprise! surprsie!). It is interesting to note that in the Wellcare Classic plan, my mom pays down her deductible monthly and never reaches her $400 maximum. Consulting Wellcare Classic’s Summary of Benefits, I see that the deductible is only applied to Tiers 2-5 drugs and my mom takes only one drug ( a Tier 2 drug) where the deductible applies. Her copays on five out of six drugs are $0.. In the SilverScript Choice plan (which has a $0 deductible), my mom pays copays on all of her drugs. The SilverScript Choice plan design is the second cheapest Medicare Part D plan only because my mom’s one Tier 2 drug costs only $180 per year (below the $400 Wellcare Classic deductible). In other words, if my mom needs additional Tier 2-5 drugs during 2017, her total out-of-pocket spending can easily increase and Wellcare Classic plan will then be more expensive than the second cheapest Medicare Part D plan. If I could only predict the future…
I have to admit that the 2.5 (below average) star rating for the Wellcare Classic plan does give me pause. I tried to understand how the overall Star Rating is calculated and got lost in the 153 page document that I found. The four categories that make up the star rating are not weighted evenly and the rating is adjusted from year to year making it difficult for a consumer to see if it is important or not. In the figure below, I compare the star ratings for the three cheapest Medicare Part D plans on my mom’s list. I have only revealed the details on the category where Wellcare Classic is below average (circled in red).
If I look at the individual categories, Wellcare Classic only has a rating below 3 (average) in one category (Member Experience with the Drug Plan). I don’t understand how the category above it (Member Complaints and Changes in the Drug Plan’s Performance) can be above average at the same time. Even though the Humana-Preferred Rx Plan has a higher overall star rating (3=average) than the Wellcare Classic plan, the Humana plan has a greater number of below average categories. When I looked up the sanctioned plan on my mom’s list, it had a star rating of 3. While many websites say to go with a plan that has at least a 3 star rating, my analysis shows me that our government needs to work on their quality rating system for Part D plans more before I will discount a plan based on it.
I also looked at Wellcare Classic’s star rating for the previous year (using the clickable link in the above figure) and found that it remained the same. The Humana Preferred Rx plan, on the other hand, has gotten worse.
Individual Medicare beneficiaries are at a great disadvantage when buying sophisticated insurance products fine tuned for maximum profit generation. Choosing the cheapest Part D plan today for future possible needs requires a crystal ball and an intimate knowledge of plan design that the majority of consumers simply do not have. This does not stop our government from making us shop every year. The private companies selling Medicare Part D plans are taking more of our money than they should because we lack the time, knowledge, desire, or even energy to extract the best price out of them. Our inaction only hurts us. It is important to evaluate your Medicare Part D prescription drug coverage during the annual Medicare Open Enrollment period for best “current” price. I say “current” because only people who have very recently been diagnosed with a disease or condition that has a known drug regimen are in a position to predict future needs.
Your particular drug list defines which plan design (i.e., formulary/cost structure) will provide you with the cheapest Medicare Part D plan. In the last two blog posts, I have outlined how to navigate the government’s Medicare Plan Finder website to find the cheapest plans available to you in the zip code where you live. If you have family members or friends who are less capable of going through the process I described, please lend a hand. You need a basic understanding of plan design (premiums, cost-share, formularies) and the ability to navigate the internet to evaluate for the cheapest Medicare Part D plan. Once you have followed this process once, it becomes easier in subsequent years.
My mom has had no complaints about any of her Part D plans in the past, but then again, as a person who spends relatively little on drugs (all generic), she is a money-maker for her plans. She does not demand a rebate or incentive payments for keeping her drug use low. Even if next year brings unexpected drug needs, My mom can always change during the next annual Medicare Open Enrollment to a plan whose design matches her new drug needs for the lowest spending.
If you find your future prescription drug needs increase (especially with expensive branded and specialty drugs), then you will enter a whole new world filled with (1) higher out-of-pocket costs, (2) formulary limitations, and (3) appeal process headaches. In this world, you will finally see how your for-profit private plan reacts to your attempts to get them to cover the expensive drugs you may need. People whose drug needs are increasing will usually find that changing plans during Medicare Open Enrollment is critical if you want to save money.
Based on my evaluation, I am leaning toward the cheapest Medicare Part D plan on my mom’s list (Wellcare Classic), but will first evaluate the possibility of switching to a Medicare Advantage plan before hitting the enroll button located next to the plan in her Medicare Plan Finder list. Don’t wait until the last minute (December 7 is the last day) to change plans. Good Luck.
Where To Get Unbiased Medicare Plan Advice
BB’s Medicare Open Enrollment: Where Do I Begin–how to navigate the government’s Medicare Plan Finder website
BB’s Medicare Open Enrollment: Stand-Alone Prescription Drug Plans –assuming mom stayed with original Medicare
BB’s Medicare Open Enrollment: Medicare Health Plan Choices–BB collects information about the Medicare Advantage plans available to her mom
Evaluating Medicare Choices For Mom–Conclusions –learn why my mom chose to stay with original Medicare + Medigap F policy + the cheapest stand-alone Part D plan instead of changing to Medicare Advantage