How To Handle Drug Plan Being Discontinued

Question: I got notification that my Prescription Drug Plan coverage will no longer be offered in 2023. What should I do?

Answer: This year there has been very little change in the number of stand-alone Prescription Drug Plans (PDP’s) offered in New York state. In 2022 and 2023 we have 19 plans, but there are changes. There is one new plan and one plan that no longer is offered.

It sounds like you have Original Medicare, a Medicare Supplement Plan (Medigap) and a stand-alone PDP.

Let’s review some of the changes that are happening to the PDP’s in 2023.

Everyone who has the PDP Cigna Essential Rx, ($42.30 per month) will definitely have to make a new choice for 2023. This plan is no longer available in 2023. These individuals have additional time to find and enroll in a new plan, from October 15 to February 28, 2023. Enrolling into your new plan between December 8 and December 31, means your new coverage would begin 1-1-23. If you wait until after 1-1-23, you will not have prescription drug coverage for January and potentially February 2023. There wouldn’t be a penalty, but you would be without drug coverage for that period of time.

A new Cigna PDP this year is called Cigna Saver Rx. This plan has a monthly premium of $13.30, which is the third lowest premium in 2023.

Fifteen out of Nineteen plans have increased their premiums and three plans lowered their monthly premiums. Some of these increases are significant monthly increases to their premiums.

The PDP changes each year can be in the form of the monthly premiums, the way your medications are placed in tiers, what those tiers cost, and the pharmacy network. If you take very little medication or no medication, there may be a cheaper option for you in 2023.

The information on the new 2023 plans are available via the medicare.gov website, as well as 1-800-MEDICARE. These are both available 24 hours a day, seven days a week now, (any time after 10-1-22). You have the opportunity to change your coverage choice between October 15 and December 7. So, anytime is the perfect time.

There are agencies and programs available locally to help you find new insurance such as, Office For the Aging (716-753-4582), Southwestern Independent Living Center (716-661-3070). Senior Life Matters, (716-720-9797) can help work through these insurance issues all year long. Insurance companies also have staff available (Brokers and 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 PDP premium for all the plans in New York State has increased to $57.24, which is a significant increase from 2022. The minimum coverage allows for a $505 deductible. Next is the initial coverage stage. The initial coverage period ends at $4,660 in total drug costs. At $4,660 in total drug cost, you enter the coverage gap, where your cost for 2023 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 enter the coverage gap or even close to catastrophic coverage.

If your plan is no longer available in 2023 you must evaluate the alternatives and enroll in something new to begin Jan. 1, 2023. For most of you, your current Prescription Drug coverage is available in 2023, but it is definitely worth evaluating. I have counseled many people who are paying too much for their coverage or who stay with a plan that doesn’t cover their medications adequately.

If your plan is no longer available you actually have some extra time to make your new choice, but if you wait and make a choice after Jan 1, 2023 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!

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email SLM@lutheran-jamestown.org.


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