QUESTION: What happens if my Prescription Drug Plan is no longer offered in 2021?

Each year as we approach the new year’s plans being announced I worry about plans going away. This year there are only three plans that will not be offered in 2021. Those three plans are Magellan Rx Medicare Basic ($35.80), Journey Rx Standard ($32.80) and Journey Rx Value ($26.10).These plans haven’t been the most popular plans, but if you have one of these plans you can’t ignore this information!

It sounds like you have Original Medicare, a Medicare Supplement Plan (Medigap) and a Stand Alone Drug Plan (PDP).

The plan that changes the most year to year is your Prescription Drug Plan (PDP). This PDP change each year in the monthly premiums, the coverage the plan gives you on your medication, and the pharmacies considered to be “in-network”.

There are 27 PDP’s available in 2020. In 2021 there will be 28 PDP’s available. Since I said three plans will no longer be offered, that means there are four new plans. There are also plans that changed names. Some plans have increased their premiums and some have lowered their monthly premiums. The cost of your medications will also change. The way your medications are placed in Tiers, and what those Tiers cost you during each phase of coverage may change. If you take very little medication or no medication, there may be a cheaper option this year. But review your choices available using some of the tools out there.

The information on the new 2021 plans are available via the website, as well as 1-800-MEDICARE. These are both available 24 hours a day, seven days a week between October 15th and December 7th. So, anytime is the perfect time!

You also have agencies and programs that are available locally to help you find new insurance. There is Office For the Aging (716-753-4582) staff available to help with insurance questions throughout the year. Southwestern Independent Living Center (716-661-3070) also has staff available to help with insurance issues. There is also Senior Life Matters, (716-720-9797) that can help work through these insurance issues all the time, but especially this time of year. The insurance companies themselves also have staff available (Brokers & Insurance Agents) to help you make your decisions. Remember that a broker can ONLY talk about the products they offer (that they sell). Be sure to visit/talk to other companies before you sign the dotted line.

The average premium for all the plans in New York State is $42.27 per month. The minimum coverage allows for a $445 deductible. Next is the initial coverage stage. The initial coverage period ends (and the coverage gap begins) at $4,130 in Total Drug Costs (means not only what you pay but what the medication costs according to your insurance and your pharmacy). At $4,130 in total drug cost, you enter the Coverage Gap, where your cost for 2021 is 25% of the retail cost of your medications. Lastly is Catastrophic Coverage (5% of the cost). Most individuals do not take enough medication to get to the Coverage Gap or even close to Catastrophic Coverage.

If your plan is no longer available in 2021 you must evaluate the alternatives and enroll in something new to begin 1-1-21. For the rest of you, your Prescription Drug coverage may not need to change, it is worth evaluating. I have seen many people who are paying too much for their coverage when they take very little medication. I have also seen people who stay with a plan that doesn’t cover their medications adequately when better products are out there.

If your plan is no longer available you actually have some extra time make your new choice, but if you wait and make a choice after 1-1-21 your coverage will be delayed to the first of the following month.

You know I never recommend waiting! Good luck and Happy Insurance Season to you!