Part D mistake

When selecting a Medicare Advantage plan with Part D (drug coverage), it is important to check all of a person’s prescriptions to be sure they are covered by the plan and what the co-pay will be.  I thought I had done this for a new client – but she left one prescription off her list.

I had asked my Mary (not her real name) to write down her prescriptions so I could check to see how they are covered by the Medicare Advantage plan that seemed to be the right fit for her because all of her doctors were in the plan network.

The plan that seemed to be the right fit for my Mary was the AARP Medicare Complete Plan 1 (by UnitedHealthcare) because of its large doctor network.  The Summary of Benefits book has a list of the most common prescriptions, so it is easy to make sure a person’s drugs are covered and at what co-pay.  I did this with my Mary while we sat at her at her kitchen table.

I explained to Mary that the benefits (co-pays and max out-of-pocket) are good in this plan, but that it does have a deductible in the drug coverage.  But the deductible does not apply to generics.

I went through Mary’s drug list and told her what her co-pay would be on this plan – and all of her drugs were generics, so the deductible would not apply to them.

That was last month, and Mary’s Medicare Advantage plan took effect on February 1st.  When she went to fill her prescriptions, she got a big surprise and called me to complain.  She said her co-pay for Oxycodone was over $50 – and she was very upset.

I pulled out my notebook and saw the list Mary had written, and……. she had neglected to write down Oxycodone.  As it turns out, this is a generic and it has a $9 co-pay on some Advantage plans – but not the AARP Medicare Complete Plan 1.  United labels Oxycodone as a Tier 3 drug (a brand) and the deductible in the drug plan applies to it.  Ouch!

Mary is stuck in this plan and she is stuck paying a lot for this drug.  I would not have enrolled her in this plan if she had told me about her Oxycodone prescription – but she forgot to tell me about it.

The lesson here is that a person must be sure to list ALL OF THEIR PRESCRIPTIONS when they are considering a Medicare Advantage plan.  They cannot assume a generic will be priced as a generic – or that it will even be covered by the plan.

I guess I need to ask my clients several times, “Are you sure you have listed every one of your prescriptions?”  I don’t want to experience another Part D mistake – even if it wasn’t mine.

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