Connect
Comment receiving replies
Some drugs can be covered under either Part B or D - depending on the formulary. That's why I suggested she read it.
Preferred providers are determined by the insurers, who can drop them at will. And under a number of PPO Medicare plans, they concept is being used to DENY care outside the PPO, even if they don't have an appropriate specialist in network. It happens all the time with rare conditions-the insurers denies referrals to experts out of network and pushes patients back to their own preferred providers.
I just switched part D plans because the old one (an Advantage plan for Part D only) placed a medication in part d tier 3 (non-preferred name brand) in their formulary. It carried a high monthly copay. The new standard plan places it in part b or d as a tier 2 drug and allows the pharmacist to determine which costs me the least.
When a group of us on Medicare, taking the same injectable name brand medication, compared our copays in November, our costs ranged from $5 to $300 per month.
Replies to "Some drugs can be covered under either Part B or D - depending on the formulary...."
Connect
The experiences you summarize are quite eye-opening. Thank you for your perspective even if it does not square with my understanding of how it all works. Apparently, I may need to revise my understanding.
Can I assume when you refer to a 'standard plan' it is a reference to an Advantage plan and not a supplemental/Medigap plan? And if it is an Advantage plan, is it HMO or PPO or neither?
And when the group Medicare eligible compared prices for the same med, did everyone also have the same additional or stand-alone coverage? I can understand such a wide range of copays if it also includes those with Advantage HMO with and without D, Advantage with and without Plan D, Plan D stand-alone, Medigap, employee retirement plans.....unless you control for all these variables, the only thing they have in common is Medicare eligibility.