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Q1Group 2019 Drug Plan Analysis: Examples of how 2019 Medicare Part D plans can change prescription cost-sharing designs


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Q1Group 2019 Drug Plan Analysis: Examples of how 2019 Medicare Part D plans can change prescription cost-sharing designs
Published on 2018-10-19 20:25:09
Category: Annual Medicare Plan Changes


As in past years, some 2018 Medicare Part D plans are changing their cost-sharing designs for 2019 prescription drug purchases.  For example, the Cigna-HealthSpring Rx Secure-Extra (PDP) will add an additional drug tier to its formulary and the EnvisionRxPlus (PDP) plan in California will change their Tier 3 drugs from a copay of $29 to co-insurance of 15% in 2019.

In the following example, the 2018 Cigna-HealthSpring Rx Secure-Extra plan formulary had five (5) drug tiers.  In comparison, the 2019 Cigna-HealthSpring Rx Secure-Extra plan formulary has added a new 6th drug tier for Select Care Drugs--with a $6 copay.

Florida Cigna-HealthSpring Rx Secure-Extra
2018 and 2019 Medicare Part D plan Cost-sharing Comparison
  2018 2019
Monthly Premium $56.70 $61.00
Initial Deductible $0 $100 (tier 1, 2, 3 and 6 excluded)
Gap Coverage No Gap Coverage Some Gap Coverage


Tier

2018
Cost-Sharing
Drugs
on Tier


Tier

2019
Cost-Sharing
Drugs
on Tier
1 Preferred Generic $4 242 1 Preferred Generic $4 205
2 Generic $10
1,223 2 Generic $10 841
3 Preferred Brand $42 582 3 Preferred Brand $42 391
4 Non-Preferred Drug 50% 982 4 Non-Preferred Drug 50% 1,359
5 Specialty Tier 33% 635 5 Specialty Tier 31% 498
-- -- -- -- 6 Select Care Drugs $6 23
Total Formulary Drugs
Browse 2018 Formulary 3,664   Browse 2019
Formulary
3,317


In the next example, the 2018 California EnvisionRxPlus plan formulary covers 471 medications as Tier Three "Preferred Brand" medications (with a 15% co-insurance).  In comparison, the 2019 EnvisionRxPlus plan formulary covers 470 medications as Tier Three "Preferred Brand" with a $29 copay.

California EnvisionRxPlus
2018 and 2019 Medicare Part D plan Cost-sharing Comparison
  2018 2019
Monthly Premium $50.00 $12.90
Initial Deductible $405 $315
Gap Coverage No Gap Coverage No Gap Coverage


Tier

2018
Cost-Sharing
Drugs
on Tier


Tier

2019
Cost-Sharing
Drugs
on Tier
1 Preferred Generic $1 139 1 Preferred Generic $1 142
2 Generic $3 577 2 Generic $6 631
3 Preferred Brand 15% 471 3 Preferred Brand $29 470
4 Non-Preferred Drug 35% 1,460 4 Non-Preferred Drug 37%
1,247
5 Specialty Tier 25% 585 5 Specialty Tier 26% 473
Total Formulary Drugs
Browse 2018 Formulary 3,015   Browse 2019
Formulary
2,963

There are approximately 7,640 members in the 2018 EnvisionRxPlus plan who will see this change. The 25,021 members of the AR Blue Cross - Medi-Pak Rx Basic (PDP) will see their cost-sharing Tier 4 Brands change to a 45% co-insurance.

In total, 32,661 members of various stand-alone Medicare Part D plans will see one or more of the drug tiers change cost-sharing from either coinsurance to copay or copay to coinsurance.

To compare annual changes in Medicare plans, our PDP-Compare and MA-Compare tools show the 2018 stand-alone Medicare Part D prescription drug plans (PDPs) and Medicare Advantage plans (MAs or MAPDs) across the country and include changes in plan features such as premium, deductible, cost-sharing and formulary size changes. Our compare tools also highlight plans that will be merged or discontinued and new plans being added in 2019.

Not sure where to begin with choosing your Medicare Part D plan?
Medicare beneficiaries can telephone Medicare at 1-800-633-4227, speak with a Medicare representative, and learn more about their 2019 Medicare Part D or Medicare Advantage plan options.


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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.