Senior Life Matters

10/15/18: 2019 Prescription Drug Plans Explained

Question; I got a letter in the mail saying my insurance coverage will go up in price in the new year. What happens now? Do I have to change my drug plan? Does my supplemental insurance need to change as well?

Answer; This question sounds very similar to the last question I answered, but it is that time of year. We all want to make the best decision possible when thinking about our new insurance coverage for 2019. It sounds like you have Original Medicare, a Medicare Supplement Plan (Medigap) and a Stand Alone Drug Plan (PDP). In this situation, your Original Medicare and your Medigap will continue to ‘stay the same’ unless you want to change your Medigap. I put that in quotes because you understand that your Medicare Part B premium may change, but your COLA (Cost Of Living Adjustment) adjustment to your Social Security will cover that change so you probably won’t notice a difference in cost. Your Medigap plan premium might change as well. Many individuals have said they have heard from the insurance company about ‘proposed’ changes. This usually means your monthly Medigap premium will probably increase, you will hear for sure in the coming weeks.

Your actual Medigap coverage will not change unless you choose a different plan altogether (example; switch from Plan C to Plan N).

The plan that usually changes the most year to year would be your Prescription Drug Plan (PDP). This PDP changes each year in any one of several ways. The premium the plan charges you each month may go up (or down); the coverage the plan gives you on your medication may be more or less comprehensive; co-pays and deductibles may be different; and the pharmacies considered to be “in-network” or “out of network” may also change.

There were 20 PDP’s available in 2018, There are 23 PDP’s available in 2019. There is one plan that has changed the name (First Health Part D Value Plus is now Aetna Medicare Rx Value Plus). That means that there are three entirely new plans.

I have the following list of the plans offered in New York State. This information is taken from the CMS/Medicare websites.

Note that this is simply a list of the plans available. But this at least allows you to look up your current plan premium and compare that to the others offered. It also allows you to evaluate the deductible. This list does NOT allow you to evaluate the medication coverage of your medications.

The average premium for all the plans in New York State is $39.33 per month, that is only 33 cents more than last year. That is a good sign. The minimum coverage allows for a $415 deductible. Once you have met the deductible you are in the initial coverage stage. The initial coverage period lasts (and the coverage gap begins) when $3,820 in total drug costs has been spent. Your medication would need on average to cost more than $318 per month to hit the Coverage Gap before the end of 2019. The Total Drug Costs means not only what you pay but what the medication costs according to your insurance and your pharmacy. Once you hit $3,820 in total drug cost, you enter the Coverage Gap. Your cost during the Coverage Gap for 2019 has gone down again. The Coverage Gap cost is 25% for Brand Name Medications and 37% for Generic Medications to you.

Most individuals do not take enough expensive medication to get to the Coverage Gap or even close to Catastrophic Coverage. In 2019 if you do get into the Coverage Gap you have spent less on your medications than you did in 2018. That is good news.

Note that most plans have increased their premiums (11), some have lowered their monthly premiums (7), and some stayed the same (2). The cost of your medications will also change. The way your medications are placed in Tiers, and what those Tiers cost you each year 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 least expensive plan premium this year is a new plan at $15.50.

The information on the new 2019 plans is 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 use those off hours to call and get the information you need. If you are using the website anytime is the perfect time!

You also have agencies and programs that are available locally to help you find new insurance. Of course, that is what we do every day at Senior Life Matters. There is Office For the Aging (716-661-8940 or 716-753-4471) staff available to help with insurance questions throughout the year. Southwestern Independent Living Center (716-661-3010) also has staff available to help with insurance issues. The insurance companies themselves and local Brokers are also available to help you make your decisions. Remember that an insurance agent or broker can ONLY talk about the products they offer (that they sell). So, this is a lot like buying a car. If you go to a Ford dealership they can’t necessarily tell you about Toyotas. The Ford dealership can ALWAYS find a product from their lot that is perfect for you. That does not mean you should drive a Ford. Be sure to visit/talk to other companies before you sign the dotted line.

For those of you whose Prescription Drug coverage may not need to change, it is still worth evaluating different plans. I have seen many people who are paying way too much for their coverage when they take very little medication. I have also seen people who stay with a plan that does not cover their medication at all, or adequately, when better products are out there.

Don’t panic, you have until 12-7-19 to make a different choice. You know me, I never recommend waiting! I hope this answered your questions. Good luck and Happy Insurance Season to you!

To contact Janell Sluga, GCMC with questions or concerns, please call 716-720-9797 or e-mail her at