Now that we’re past October 15, we’re free to discuss more specifics as we head into the 2024 Annual Election period or AEP for short. Reminder: The AEP runs from October 15 through December 7.
As we discussed in our previous issue of Northwest Senior News, much of the turmoil and changes with prescription drug plans (PDPs) and Medicare advantage plans with prescription drugs (MAPDs) is due to the Inflation Reduction Act passed by Congress in 2022.
The Act, among other things, stipulated that Phase 4 or the catastrophic phase of the PDPs was to be eliminated in 2024. That has had a minimal effect on the 2024 PDP and MAPD plans.
Phase 3 or the coverage gap (aka donut hole) will be eliminated in the 2025 plans. Additionally, there will be a $2,000 out-of-pocket cap for covered drugs in place for those that have high drugs costs. The 25% that the plan members paid in the coverage gap will now be picked up in large part by the plans.
Prescription Drug Plan Changes
The standard deductible has increased from $545 in 2024 to $590 in 2025. Several of our clients have commented to us, “My plan increased its deductible.” Comment: All plans have increased their deductible to the new higher limit except for a very few high premium plans that do not have a deductible.
Keep in mind that the deductible generally applies to tier 3, 4, and 5 drugs. Your tier 1 and 2 generics do not have a deductible. The following is a brief update for the plans offered by the five major carriers.
- Aetna has consolidated its three SilverScript PDPs into just one plan, the SilverScript Choice (SSC) plan. Many of our clients have had the low-premium SilverScript Smart Saver That plan terminates at the end of 2024. Likewise, those with the high premium SilverScript Plus plan will be merged into the SSC plan. If you currently have the SilverScript Smart Saver plan, please be sure to contact us.
- The Wellcare Value Script This has been a very popular plan and will continue to be so. This plan works very well for those that have only tier 1 and 2 generics.
- We’re finding the Cigna Healthcare Saver Rx PDP also to be a very popular plan for 2025.
- Humana: The Humana Walmart Value plan is now just the Humana Value Rx In addition to Walmart, many other pharmacies are preferred pharmacies with this plan. Humana has lowered the premium for their Humana Basic Rx plan.
- UnitedHealthCare or UHC for short: UHC has dropped its branded AARP Walgreens They now offer just two plans, the AARP Saver and the AARP Medicare Rx Preferred plans.
- Some states such as Montana and Wyoming have two regional PDPs. These are MedicareBlue Rx Standard and MedicareBlue Rx Premier.
PDP Shrinkage
Most states had 20-22 PDPs in 2024. This number is decreasing to 12-14 plans for 2025. Contrast this to 2006 when we had around 50 plans in each state.
Medicare Advantage news
The elimination of Phase 3 has also caused a bumpy road for the MAPD plans. Here are some of the changes we have seen:
- Some zero premium plans are still zero premium, but their medical copays have increased. For example, the specialist copay may have increased by $5.00, or the inpatient hospital copay may have increased by $50 to $100 per day or more. Check with your plan’s Annual Notice of Change (ANOC) to see the extent of your copay increases.
- Some plans have had modest premium increases to help offset their projected increase in prescription costs.
- Some carriers have replaced one plan with another plan.
MAPD plans dropped
- Pacific Source has dropped its Explorer 11 MAPD in Idaho and replaced it with their Explorer 18. Their other plans are still available.
- Blue Cross Blue Shield (BCBS) of Montana has dropped its Blue Cross Medicare Advantage Flex BCBS maintains its other existing plans.
- Summit Health has exited the Eastern Oregon market altogether. That leaves many rural, eastern Oregon counties with no Medicare advantage plans at all.
- There are a handful of other companies that have discontinued one of their plans. They still have other MAPD plans to choose from.
Please contact us if you are affected by these discontinued plans.
News for Benewah, Clearwater, Lemhi, and Lewis Counties in Idaho
(St. Maries, Orofino, Salmon, Craigmont Nez Perce, and Winchester)
These four counties have been without any Medicare advantage plans in 2024. UnitedHealthCare (UHC) is now offering MAPD plans in these rural counties starting in 2025. Please check with us if you are interested in one of these new plans. Note: It appears that Butte County (Arco) is the only county left in Idaho with no MA plans.
Idaho Birthday Rule
Since March 1, 2022, we have helped dozens of our clients take advantage of the Idaho birthday rule. The new rule from the Idaho Insurance Department stipulates that you can change your Medicare supplement plan on your birthday from like plan to like plan with no health questions.
Here’s how it works. On your birthday and for two months afterwards, you can change your Medicare supplement with no medical underwriting.
For example, Fred Flintstone has A-fib. Normally, he could not change his Medicare supplement plan because A-fib causes a declined application. With a birthday rule application, the health questions are skipped. In other words, it’s a guaranteed issue plan.
We’ve seen clients save as much as $20 to over $100 per month in premium.
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